Patient dies post Liver transplantation: NCDRC dismisses medical negligence charges against Surgeon, Indraprastha Apollo Hospital
New Delhi: Ruling that the medical record doesn't indicate towards any kind of deficiency in treatment as alleged, the National Consumer Disputes Redressal Commission (NCDRC) has recently given clean chit to a surgeon and Indraprastha Apollo Hospital in a case involving a patient's death after liver transplantation.
After perusing the medical record, medical literature and taking note of the expert opinion from the Medical Board of AIIMS, New Delhi, Dr. S.M. Kantikar, presiding member of NCDRC dismissed the plea noting, "the Complainant failed to conclusively establish deficiency in service and medical negligence on the treating doctor and the hospital."
The matter goes back to 2006 when the complainant had taken her husband to the hospital for jaundice treatment. After examining the patient (36 years of age), the treating doctor, Senior Liver Transplant Surgeon, conducted investigations and admitted the patient to the hospital. The doctor advised for urgent Liver Transplantation and assured that the patient could go home ten days after surgery and could resume his normal duty after two months.
A donor was found in the complainant's mother and accordingly, the hospital obtained appropriate approvals for organ transplant from the concerned State Authorities. The cost of the operation was mentioned as Rs15 lakhs and the doctor accordingly operated on the patient on 17.12.2006.
The complainant submitted before the court that during the operation the patient suffered from significant blood loss and metabolic acidosis and for this, the patient was kept in the ICU. The doctor informed the family of the patient that the operation was successful. However, the patient didn't recover from the Anesthesia even after several hours of conducting the operation.
As the patient looked to be restless, the doctors in the ICU were informed about the same. However, the doctor kept on assuring the complainant not to worry. Yet, the condition of the patient deteriorated but even after repeated requests the doctors didn't pay any attention, alleged the complainant.
Finally, the doctor performed a second surgery hurriedly on 19.12.2006 after the condition of the patient became critical. This operation was done after realizing that there was continuous bleeding from the active bleeders which were not closed properly during the first operation, submitted the Complainant.
Alleging that the first operation was done in a very negligent and cavalier manner, the complainant further informed the Commission that the treating doctor and hospital failed to exercise proper care during the surgery and monitor the condition of the patient on an hourly basis after the surgery. In fact, the doctor delayed the second operation by two days unnecessarily resulting in the worsening condition of the patient, the petitioner alleged.
The Complainant further alleged that the doctor simply cleaned the blood and blood clots from the abdomen without locating the source of bleeding and bleeders during the second operation. As a result, the bleeding continued even after the second operation and it caused a drop in blood pressure of the patient.
After seven days of re-operation the doctor suspected fungal sepsis on 26.12.2006 and prescribed Amphotericin medicine which had little effect and ultimately worsened the condition of the patient. Due to fungal infection there was blackening of the surgical wound which was not noticed by the doctors. It further led to gangrene and the death of the patient on 29.12.2006, submitted the Complainant, adding that the cause of the death mentioned in the death summary and in the medical record contradicts with each other.
Thus, alleging gross medical negligence and deficiency in service during treatment the Complainant moved the top Consumer Court in 2008 and prayed compensation of Rs. 2,06,13,496/- along with 18% interest from the date of admission in the treating Hospital plus Rs. 50,000/- towards cost.
The treating doctor and hospital contested the complaint and denied the charges made against them. They submitted that the patient was diagnosed with Chronic Liver Cancer in 2002 and was treated at a different hospital for liver cirrhosis and acute chronic liver failure. These facts were suppressed by the patient's wife in the complaint.
When the patient was admitted to the hospital in 2006, earlier endoscopy revealed esophagial varices and MRI revealed scerotic changes with liver parenchymal disease. The operation was done on the patient only after explaining the critical condition of the patient and obtaining the high risk consent.
After the operation, the patient developed renal failure, gross coagulopathy, and severe portal hypertension. Commonly, the post-operative bleeding seen due to coagulopathy and it takes 24 to 40 hours for the transplanted liver to start functioning, submitted the doctor and hospital.
They further denied that the active bleeders were not closed properly during the first operation and submitted that few patients often need re-operation depending upon the patient's clinical assessment.
Further, the treating doctor denied that the operation site was bleeding and simply the blood clots from the patient's abdomen were removed during 2nd operation, adding that the complainant failed to prove that the bleeding continued even after the 2nd operation.
The treating doctor further mentioned that as per protocol, anti-rejection treatment is to be given to the patients after liver transplant, however, it reduces the immunity and the patient becomes prone to infections. In this case, the patient developed fungal infection and he was treated with due care as per the clinical signs. The patient expired because of the natural consequences of the chronicity of the disease, it was neither due to any negligence nor deficiency from the treating doctors.
After listening to the contentions, the Commission took noted of the medical record to note that a multi-disciplinary team of doctors treated the patient after hospitalization. The entire procedure had been done only after explaining the prognosis to the family. Due care was given to the patient during the pre-transplantation period and proper monitoring had been done after the operation.
Thus, the Commission observed,
"Fungal infections are known to be opportunistic infections in such patients. The anti-rejection treatment affects the immunity of the patient and became prone to fungal infections. There was no deficiency in the treatment as alleged. The patient developed necrosis/gangrene and septicemia which could not be attributed to negligence in the instant case."
Apart from this, the Commission also went through medical literature to note that, "The success of transplant procedure may be limited by infectious complications. Most fungal infections occurred within one month of liver transplant surgery. Bacteria, and less commonly Candida infections, remain the predominant pathogens during the immediate postoperative period, especially during the first month."
"It is estimated that up to 80% of liver recipients will develop at least one infection during the first year after transplantation, and, while most are successfully treated, some will result in death," the judgment dated 01.06.2021 added.
Besides, the Commission had sought an expert opinion from the Medical Board of AIIMS, New Delhi regarding the matter. The medical board in the expert report dated 29.07.2015 noted, "that Indraprastha Apollo Hospital and others were not negligent in treatment that was rendered to Late Sh. **** (patient)."
Finally, the Commission referred to several judgments of the Supreme Court including the case of Dr. S.K. Jhunjhunwala vs Mrs. Dhanwanti Kumar, and Jacob Mathew vs. State of Punjab. In the first case, the Supreme Court had held that a doctor or surgeon cannot assure and does not guarantee that the result of surgery would invariably be beneficial, much less to the extent of 100 % for the person operated on. In the second case, the Apex Court had mentioned that the human body and its working is nothing less than a highly complex machine and a physician would not assure the patient of full recovery in every case.
Referring to these judgments, and taking note of all the facts and contentions related to the case, the top Consumer Court dismissed the complaint noting that the
"Complainant failed to conclusively establish deficiency in service and medical negligence on the treating doctor and the hospital."
To view the order, click on the link below.
https://medicaldialogues.in/pdf_upload/medico-legal-to-write-155851.pdf
