Patient Develops Thrombotic Micro Angiopathy symptoms post Hysterectomy: Consumer Court Directs Hospital, Doctors to Pay Compensation
Mahabubnagar: The District Consumer Court, Mahabubnagar recently directed a Hospital and doctors to pay Rs 2 lakh as compensation to a patient as it noted that the Hospital failed to submit evidence to show that all precautionary measures were taken to avoid unwarranted, unusual and unknown, rare symptoms of Thrombotic Micro Angiopathy (TMA) either during surgery or postoperative time.
Such a decision was taken by the commission after it noted that the patient has been suffering from kidney problems and was under dialysis after it had undergone a hysterectomy at the Hospital.
"The documents filed by the complainant establish that the complainant is suffering with kidney problem, which caused only after the hysterectomy operation done by the OPs doctors. The OPs stated that in rare and rare conditions, the unknown and rare symptoms as developed as in the case of the complainant. However, in the absence of any evidence to show that the doctors managed medically pre and post operation and at the time of operation of hysterectomy, it appears that the OPs doctors could not manage medically during the course of the operative and thereafter and even it appears that the OPs doctors failed to manage precautionary measures for such unknown rare and rare symptoms as happened to the complainant according to the medical literature as stated by them," noted the Consumer Court.
The case goes back to 2016 when the patient was diagnosed with lump in her uterus and needed to undergo a hysterectomy. Post-operation, which cost around Rs 25,000, the patient was shifted to general ward and during hospitalization, she suffered from dehydration and after one day the complainant got retention of urine problem and motions, vomiting.
The patient alleged that following this, the doctors at the treating Hospital brought her to Osmania General Hospital, Hyderabad without informing her relatives. When the husband and the relatives of the patient queried about the situation, they were informed that as the patient was suffering from kidney problems she had to be shifted to Osmania hospital.
However, the patient claimed that even after undergoing treatment in the Osmania Hospital, she continued suffering Kidney problems and later she approached several other hospitals with the same problem to get no relief.
The patient claimed that the treating Hospital was responsible for her being on dialysis for so long as the doctors were negligent while operating on her and they also didn't take any precautionary measures after the operation as they didn't shift her to ICU which resulted in multiple health problems.
Thus, the husband of the Complainant filed a case against the doctors of the treating Hospital and the Complainant approached the District Consumer Court seeking Rs 20 lakh to help her with the treatment.
On the other hand, the doctors including a General Surgeon and a Gynaecologist at the treating Hospital denied all the allegations. They further submitted that upon investigation, the patient was found to have a fibroid uterus and that is why hysterectomy was recommended. Claiming that there was no fault in the diagnosis and treatment by the treating Hospital, they further submitted that after surgery the complainant was given post-operative care, she was monitored continuously by pulse oxymeter and pulse, BP and Urine output were also noted in case sheet.
Besides, they also contended that ICU support is given to those patients who have preoperative risk factors such as any comorbidities, and who require hemo dynamic support with ionotropes or ventilation. As the Complainant didn't have any such risk factors, there was no requirement to monitor the patient in ICU and therefore she was monitored in the postoperative ward and not in ICU as usual procedure.
Further, the case sheet submitted on the behalf of the Hospital mentioned, "The patient was stable hemodynamically and the patient developed sudden anuria unusually. The complainant was given fluid challenge and diuretic and low dose dopamine was started which is standard treatment given elsewhere also, however, there was no response to the treatment given."
Explaining that it is a rare presentation, they submitted that the doctors had immediately advised for nephrologist care and need for dialysis at higher centre and being aware of the financial condition of the patient, they referred the patient to Osmania General Hospital.
They also pointed out that the investigations conducted by Osmania General Hospital also confirmed that there was no surgical problem to the patient and so the patient was referred to Nephrology Department for further management and necessary care was given by Nephrology Department in Osmania General Hospital (OGH).
The Nephrology Department found out that the patient had thrombotic micro angiopathy (TMA), which is very very rare complex disease due to multiple causes and can be hereditary and not at all related to post operative surgical negligence as alleged by the complainant, the doctors of the treating Hospital pointed out.
In fact, the doctors further contended that during the police probe, the matter was referred to an expert committee which opined that "renal failure due to TMA is not related to surgery and has occurred due to thrombotic micro angiopathy, proved by biopsy and the treatment was given as per protocol and there is no negligence in the treatment by the OPs."
The expert committee further specifically opined that TMA is due to multiple reasons and sometimes due to genetic causes of compliment defects.
So, the doctors from the treating Hospital submitted that the allegations brought by the Complainant were baseless and when the problem was in no way connected to the surgery, the question of payment of alleged expenditure incurred by the complainant had no ground.
The Commission noted that even though the Complainant filed several evidences in support of her arguments, the doctors of the treating Hospital only filed the counter and they did not adduce any evidence either by themselves or any other witness and no documents were filed to support their version as stated in their counter.
"Whatever the statement made in respect of treatment explained in the counter, the OPs failed to produce all the material papers before the Commission to establish that they have opted all the precautionary measures," noted the Commission.
It was further observed by the Commission that in the absence of documentary evidence, "the version of the OPs doctors cannot be justified and they could not establish that there is no negligence on their part."
On the other hand, after perusing the evidence submitted by the Complainant, the Commission noted,
"The documents filed by the complainant establish that the complainant is suffering with kidney problem, which caused only after the hysterectomy operation done by the OPs doctors. The OPs stated that in rare and rare conditions, the unknown and rare symptoms as developed as in the case of the complainant. However, in the absence of any evidence to show that the doctors managed medically pre and post operation and at the time of operation of hysterectomy, it appears that the OPs doctors could not manage medically during the course of the operative and thereafter and even it appears that the OPs doctors failed to manage precautionary measures for such unknown rare and rare symptoms as happened to the complainant according to the medical literature as stated by them."
Further addressing the rare symptoms of the patient, the Commission further observed,
"If such rare and rare symptoms develop to the patient, the doctor who operates must take full care and attention and all precautionary steps as laid down in medical literature without any negligence. In the instant case, it appears that there is no evidence to that extent that the OPs doctors have taken all precautionary measures to avoid unwarranted, unusual and unknown, rare symptoms either during conducting surgery of postoperative time or at any point of treatment till discharge of the patient with good condition from the OPs hospital without any complications."
Although the Commission noted that there was no proof that the Complainant spent Rs 20 lakhs for treatment, it also accepted the fact that she was suffering from kidney problem and she is under dialysis.
"So, it appears that she might have spent certain amount earlier and in future also she has to spend money for dialysis and towards further treatment, for which, we are of the opinion that a reasonable and consolidated compensation is necessary to be granted in favour of the complainant, which is liable to be paid by the both OPs doctors," noted the Commission.
Thus, concluding that there was deficiency on the part of the treating Hospital in rendering services to the Complainant, the Commission directed the doctors representing the Hospital to pay Rs 2 lakh towards compensation, and Rs 10,000 towards cost of the proceedings within one month.
To read the order, click on the link below.