Patient with CSF Rhinorrhea paralysed after lumbar drain: NCDRC slaps Rs 15 lakh compensation on Ludhiana hospital, neurologist, anaesthetist
compensation
New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently directed a Ludhiana-based hospital and two of its doctors, including a neurologist and anaesthetist, to pay Rs 15 lakh compensation to a patient who suffered paralysis after undergoing surgery for CSF Rhinorrhea treatment.
After going through the case records, the Apex Consumer Court concluded that there was not the required degree of care, caution, preparedness and responsiveness to quickly identify and investigate the post-operative complications.
"On the basis of all these factors, we are of the considered opinion that a lumpsum compensation of Rs. 15 lacs with 6% interest from the date of complaint till the date of payment shall be just, reasonable and proper in the facts and circumstances of the case. We also direct that 90% of the liability shall be borne by the Hospital while 5% each shall be borne by the two doctors. The cost of Rs.25,000/- to be paid to the complainants shall also be borne by the Hospital. The order shall be complied with on or before 04.10.2026, failing which the enhanced rate of interest of 9% shall apply on the amount remaining unpaid from 04.10.2026 onwards," ordered the consumer court.
Case Background:
The history of the case goes back to September 2011 when the patient noticed unusual leakage of fluid from her nose, and accordingly she was admitted to the Ludhiana hospital and underwent endoscopic repair for CSF rhinorrhoea.
However, the leakage recurred and therefore, a lumbar drain was placed to assist the treatment. Subsequently, the patient developed worsening pain, numbness and weakness in her lower limbs. Painkillers were given. However, the patient's lower portion of the body was found to be paralysed.
When none of the treatment administered by the treating doctors could yield any results, the patient was shifted to Medanta Hospital, where an MRI brain contrast test was conducted, and it allegedly indicated that she was paralysed after the surgery performed by the treating doctors at the Ludhiana Hospital. Following this, the patient underwent treatment at Indian Spinal Injury Centre also. However, her condition did not improve.
Alleging negligence of the treating doctors in the diagnosis, treatment, surgery and post-operative care and consequential deficiency in service, the patient and her husband filed a complaint before the Apex Consumer Commission, praying for compensation.
On the other hand, the treating doctors and hospital denied negligence and claimed that the patient was treated as per standard medical practice. They argued that the correct line of treatment was given to the patient and there was no deficiency in service.
They submitted that the patient was diagnosed with CSF Rhinorrhea. To confirm this diagnosis, further tests, i.e., CT cisternography and MRI were performed on her. Her relatives were explained in detail about the disease and the treatment available, i.e., endoscopic repair/open craniotomy and repair of the CSF fistula. Her relatives were also informed that in 10 to 20% of the cases there is a likelihood of recurrence of CSF rhinorrhea and in that case she may have to undergo open craniotomy and repair of the CSF rhinorrhea.
Further, it was submitted that the surgery was uneventful and the patient came out of anaesthesia normally. They claimed that the leakage of CSF from the nose had stopped after surgery and that no leakage was detected on the day of surgery. However, the next day, it was noticed that there was a small amount of recurrence of leakage from her nose.
Her relatives were again informed that there is a delay in healing of the repair defect, as in some cases it takes time for glue and fascia lata to stick properly. In such type of patients, if CSF flow is diverted via a lumbar drain, which makes the area of repair dry, there are better chances of proper healing, and treating doctors advised that a lumbar drain be placed to divert the flow.
According to the doctors and the hospital, the patient had the misfortune of having been visited by transverse myelitis. At no point in time in the OP Hospital or in subsequent investigations (CSF Study, MRI) conducted at Medanta Hospital, was it proved that she had developed CSF infection due to the lumbar drain, they argued.
Observations by NCDRC:
NCDRC considered the arguments and perused the material on record. The Commission mainly focused on the hours after the lumbar drain was placed.
The Commission noted that a recovery note at 5:30 PM on September 23 recorded that the patient complained of discomfort in bilateral lower limbs persisting since pre-procedure time.
NCDRC observed that the complainant had alleged that the bilateral pain in the lower limbs continued and increased, regarding which repeated complaints were made, but apart from administering pain-killers, no effective and meaningful consultation or investigation was carried out.
While the hospital claimed that a doctor had visited the patient at around 9 PM, the Commission observed that "the medical record is silent about such visit or the advise, treatment or investigation if any suggested by Dr***."
The following morning, and MRI was conducted, and the report suggested "spinal thoracic cord myelitis with arachnoid enhancement?” and also "arachnoid enhancement around the conus and lower spinal canal”.
After minutely perusing the doctor's notes from the time of lumbar drain till the diagnosis of "acute transverse myelitis", along with the explanation about the occurrence of the myelitis as given by the doctors in the reply and affidavits, the NCDRC bench observed that there was no history of any spinal complaint or any averment or explanation of the OP of any co-relation of lumbar spinal region and nerve functioning therein with the CSF Rhinorrhea or surgery, as either pleaded or explained by the OPs.
"Nor is there any specific explanation of Therefore, the position of the spinal inflammation and observations in the MRI has, in our opinion, to have its genesis at nowhere but in the procedure of lumbar drain. It has been explained through literature that the myelitis has idiopathic or viral origin, but none of these factors logically or medically seems attributable for the patient’s infliction of myelitis. The patient’s condition was otherwise fine and there was no spinal issue or issue of any viral infection affecting the spine, which also is subsequently concluded through CSF culture report. The OPs together were obliged, in our considered opinion in the present case, to provide a technical, self-explanatory and detailed explanation of (i) The most probable genesis of the onset of the Myelitis, and such accelerated progress within 15 hours resulting in motor power of 0/5, and (ii) the meaning and implication and most probable cause of findings as recorded in the MRI report alongwith explanation thereof and (iii) Why there is no periodic monitoring of motor power after the drain procedure (iv) Why the likely complication of onset of myelitis, or the pain/numbness in the lower limbs as symptoms of likely aftereffect/complications post drain-placement, when seen with the increased pain and numbness when in fact noted, was not considered critical, and if so considered, what steps of treatment/investigation were taken during the night," the Commission observed at this outset.
"It is easy to label, and it may also in fact be, a complication or a phenomenon caused by or due to even a pre-hospitalisation event or infection, or which arose due to either some complication or some idiopathic reasons, but that does not explain the complete medical inaction to be conscious of, investigate and arrest the accelerated progress thereafter. As a matter of fact, we even fail to comprehend as to why, in the face of an unfortunate sudden Myelitis developing to a patient within a short time during the night, the Hospital itself as a responsible institute, and as a part of self-learning and system-perfection measures, has not considered it fit to analyse the episode and has not placed the internal technical report obtained, if any, when the episode itself, considering the nature of the complaints with which a non-comorbid young patient of 36 years had been admitted and treated in the hospital, and which from the yardstick of any ordinary man, in any case, is not ordinary or acceptable, and when the particular risk itself has not even been mentioned in the likely risk in the consent form obtained by the hospital," it further noted.
The Commission concluded that there was no positive evidence of any violation of or deviation from any treatment protocol on record, nor is there any expert opinion on record. Still, from the facts emerging from the medical documents, it concluded that "the consulting and advisory notes of the treating surgeons and consultants leave much to be desired as the notes themselves lack continuity, progressive record of the condition of the patient and the treatment and the investigative directions and, on the other hand, reveals, that during the critical night of 23rd, no substantive action, urgency, care or investigative urgency is disclosed by the Medical experts and the whole team who were in charge of the patient or who were entrusted with patient care, or who, as pleaded, were telephonically informed."
"The MRI result itself, which showed inflammation at the drain-site, and which lead subsequently to the clinical diagnosis of Myelitis involving bladder and bowels, was received on 24th at 4 pm, which, as is obvious, could have come much much earlier, when it is indeed not the case of the hospital or otherwise inferable that the patient condition required any restriction on movement for shiting the patient for MRI. Though lumbar drain is stated to be a mere “bed side” procedure, and though there is no positive evidence led by the complainant or otherwise emerging from the record, of any negligence or lack of skill or application of such skill in the procedures themselves, the outcome and diagnosis of Myelitis within 24 hours of the procedure of lumbar drain would strongly lead to the circumstantial conclusion that the most probable cause of Myelitis, in the facts of the present case, suffered by the patient is categorically to be found, on preponderance of probability, only in the procedure of placing lumbar drain, though, we would refrain from rendering any such finding of a negligent and defective or deficient expertise of Dr. ***, who undertook the procedure, in deference to and in light of a series of Supreme Court and this Commission’s decisions relied upon by the OPs which lay down that the finding of deficiency in the medical procedure or the treatment or skill and medical decisions of the professional cannot be arrived in the absence of positive evidence thereof and unless the medical and academic expert opinions are obtained and available, which technically lead credence to such conclusion," it further held.
Accordingly, the Commission opined that it would not be safe and proper to conclude that the placement of lumbar drain itself was deficient in any way or exhibited any lack of expertise because though most likely, it is impossible to conclude the same on the basis of available evidence.
"As such, the likelihood of the emergence of Myelitis can at least theoretically be attributable to even the pre-hospitalization infection or even to accidental movement by the patient herself, we are of the opinion that an expert’s endorsement was necessary before we could validly conclude any deficiency in the lumbar drain placement process itself and therefore we also conclude that the onset and sudden acceleration of Myelitis itself it is no evidence of any medical negligence or deficiency in the procedure. It even remotely does not appear to us that there was anything deficient or wanting with regard to the conduct of the first CSF repair surgery," it held.
However, the Commission held that the circumstances suggested that the repeated and pre-procedure complaints of the patient of continuing pain and increasing numbness in the lower limb, and enhancement therein after the procedure, in any case, needed to be taken as an alarm by the medical officer and caregiving team leading to proper communication with the experts "because it is evident from the final quick outcome that though rare and infrequent, but a very serious and life-changing complication could and did arise from or after the procedure as a complication."
"The team of experts and residents, within the parameter of normal possession and application of expertise, skill and technical knowledge can validly be expected to be on an enhanced degree of responsiveness and urgency in calling the higher experts, carrying out the investigations, and take appropriate steps even remotely indicative of the complications likely from the surgery or procedure, when the procedure undertaken is also likely to cause as serious a complication as Myelitis. It is not clear, as indeed it cannot be, as to whether any more urgent and more timely MRI and the diagnosis of inflammation, which otherwise clinically is also noted in the doctor’s notes, in the area of drain could have prevented the injury or complication or the extent thereof," it further observed.
NCDRC concluded that there was no proper and satisfactory explanation regarding the time consumed by the hospital's system from 5:30 PM of 23rd when the patient was already complaining of pain and numbness in the thighs and in the legs to 1 pm of 24th before the MRI result and consequent consultation and treatment could start, particularly in the face of the repeated and continues complaints of “pain and numbness in the lower limb”.
"The whole team, the resident incharge and the nursing staff could and should have obviously been able to clinically take measure/diagnose the continuing reduction in the motor power of the lower limbs, indicative of some urgent investigation or treatment...The hospital system itself should have ensured speedier MRI and speedier expert-neuro advise which perhaps could have resulted in the speedier diagnosis and treatment," observed the Apex Consumer Court.
"Our final conclusion is that there is collective lack of urgency with which the team of incharge experts and the hospital’s system could have responded given the procedure underwent and the complaint/feed back constantly provided by the patient. There is some lack of transparency and clarity in the doctor’s notes, which could have provided more detailed picture of the line of technical pros and cons, the decisions, if any, taken during the night and the treatment options considered," it concluded.
Even though the Commission could not find any positive deficiency in the conduct of the procedure and the line of treatment when it was in fact provided, it still held one of the treating neurologists, the anesthetist, and the hospital collectively liable for
"for any positive medical negligence per se, but for not having sensitised and having prepared the team attending the patient in their absence during the night, of all possible patient-complaints which needed further quick consultative and diagnostic actions, particularly those of continuing pain and numbness in the lower extremities in the context that lumbar region has been punctured and has continuing invasive in situ drain, which obviously need both additional specific care of the drain and quickness of identifying the signs of sensory loss."
"We are also of the opinion that after RMO noting on 24th early morning of pain, numbness and motor power of one out of five, the hospital system and protocol in such circumstances after such procedure, should have shown more accelerated, informed and expert response from the available or augmented expert resources while also ensuring the treating surgeon’s and anesthetists visit, if so required. There is nothing in the doctor’s notes or progress sheets as to what positive actions, particularly, to rule out or identify the likelihood of onset of myelitis, which was definitely required to be anticipated or foreseen as a likely complication of the lumbar drain procedure, were taken in response to the patients complaints," it concluded.
The Commission also observed that the conduct of the hospital team "does not seem to match up to the requirements of monitoring of the patient post placement of drainage in the face of evidenced loss of sensory power.' It also exonerated a senior neurologist in the case, stating that when his consultation was sought, he had "duly, timely and effectively responded."
Finding the complainant's claim seeking Rs 2 crore in damages excessive, the Commission awarded the complainant Rs 15 lakh lump sum compensation with 6 per cent interest from the date of the complaint until payment.
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/2026/08/13/ncdrc-364962.pdf
