SC upholds MCI findings, sets aside Consumer Court order absolving surgeon, Hospital of medical negligence in Laparoscopic Cholecystectomy
New Delhi: Upholding the report of the Ethics Committee of the erstwhile Medical Council of India, now National Medical Commission (NMC), the Supreme Court recently held a laparoscopic surgeon at Preet Surgical Centre & Maternity Hospital guilty of medical negligence while conducting a laparoscopic cholecystectomy back in 2004.
Such a decision was taken by the Apex Court bench comprising of Justices UU Lalit, S. Ravindra Bhat and PS Narasimha as it held that the opinions and the findings of the MCI were of "great relevance" and set aside the orders of the National Consumer Disputes Redressal Commission (NCDRC) which had earlier exonerated the doctor and the hospital.
Directing the doctor and the hospital to pay Rs 25 lakh as compensation the bench noted, "Having considered the matter in detail, we are of the opinion that the NCDRC has committed an error in reversing the findings of the SCDRC and not adverting to the evidence on record including the report of the MCI. The decision of the NCDRC deserves to be set aside and we hold that the complainants have made out a case of medical negligence against Respondents 1 and 2 and are entitled to seek compensation on the ground of deficiency of service."
The history of the case goes back to 2004, when the wife of the complainant had developed abdominal pain and after conducting USG, it was revealed that there was gall bladder stones. Consequently, the patient approached a laparoscopic surgeon at Preet Surgical Centre & Maternity Hospital. After due examinations, the surgeon performed a laparoscopic cholecystectomy and placed a drain in the patient's abdomen.
The next day, the patient complained of abdominal pain and distension. The drainage tube was showing a discharge of fluid which was slightly green in colour, which later on turned greenish-brown. However, even though the complainant kept expressing his concern regarding the situation of the patient who later developed difficulty in breathing, the doctor went on assuring that the patient was alright.
Later the treating doctor informed the complainant that the cause of the problem was acute pancreatitis and that there was nothing wrong with the surgery. However, the complainants remained unconvinced, especially because of the dirty brown discharge coming through the drain and the persistent pain, distension and breathlessness which were indicative of some major intestinal or bile duct injury, alleged the complainant.
Following this, the doctor decided to shift the patient to Dayanand Medical College and Hospital, Ludhiana. However, he declined the request of the complainant to give detailed patient records and operation notes by stating that the patient's condition had been adequately explained to the doctor, to whom the patient had been referred to.
Meanwhile, as per the suggestion of the on duty doctor during admission there was suspicion of an iatrogenic injury to the bile duct and possibly also to the intestine, during the previous surgery. After conducting CT scan it was revealed that there was moderate intra-abdominal and sub-phrenic collection.
The condition of the patient worsened and she went into multi-organ failure which led to her death. It was submitted by the Complainant that when he discussed the cause of death and the need for autopsy with the on-duty doctor of the second hospital, he was allegedly told that the patient died due to intraoperative injuries to the colon and bile duct resulting in Peritonitis, Peritoneal Collection, Septicaemia and Multi-Organ failure.
At such an outset, the complainant approached the State Consumer Disputes Redressal Commission (SCDRC) and prayed for monetary compensation quantified at Rs. 62,85,160 for negligence and deficiency of services. However, the treating doctors and hospitals denied any negligence on their part.
After considering the entire medical record and evidence, the SCDRC held the treating doctor and the first hospital negligent and directed them to pay Rs. 15,44,000 jointly and severally and Rs. 10,000 as costs.
Meanwhile, during the pendency of the matter before the SCDRC, the complainant had moved to the Punjab Medical Council against the professional misconduct of the Respondents, which was summarily disposed of. Following this, the complainant had approached the Medical Council of India. After considering the matter, the Ethics Committee of MCI held the laparoscopic surgeon medically negligent and issued a strict warning to be more careful during the procedure and to be more diligent in treating and monitoring his patients during and after the operation.
On the other hand, after the order of the SCDRC, the appeal had reached the NCDRC, which set aside the order of the State Commission and held that negligence was not proved by the complainants. Following this, the matter reached the Supreme Court.
The counsel for the appellants submitted several facts including the fact that the patient had two iatrogenic injuries during her first surgery, one to the colon and the other to the bile duct. Secondly, the counsel argued that instead of referring the patient to a nearer facility, the doctor had referred the patient to Ludhiana. Further, the counsel referred to the statement made by the doctor during the cross examination, where he had categorically stated that it did not occur to his mind that the injuries could take place. He also contended that the doctor at the second hospital negligently delayed the re-exploration surgery even after receiving the CT scan report.
On the other hand, the counsel for the doctor and hospital argued that presence of a biliary leak does not signify injury of a bile duct as it can occur from the liver bed from the cholecycto-hepatic duct, slippage of a clip from cystic duct stump which are not injuries. Second, for there to be a presence of a leakage from the large intestine, there are some specific symptoms which were not shown and therefore leakage of the colon was ruled out. Finally, since there was no bile duct or colon injury, the presence of rent in the hepatic flexure of the colon may be either a result of delayed manifestation due to thermal injury because of the electro-cautery, or it may be a rare case of injury to the hepatic flexure of the colon because of the drainage tube.
The counsel for the doctor at the second hospital pointed out that the only allegation against them was the delay in diagnosis of colonic perforation and corrective surgery. The counsel argued that this was proved to be incorrect as per the findings of the MCI, SCDRC and the NCDRC. She further pointed out that the condition of the patient was already critical when she was admitted to the second hospital and therefore immediate surgical intervention was not called for.
After considering the contentions, the Supreme Court took note of the fact that the substantive part of the NCDRC's decision referred only to judicial precedents on the question of medical negligence and NCDRC did not meet the specific allegations of negligence in the performance of the laparoscopic surgery.
"There was sufficient material indicative of large bowel perforation after the laparoscopic operation. It is true that it may not have manifested immediately in the normal course. However, there were sufficient indicators to a diligent professional, to detect and take immediate steps for restitution. Instead of examining the material that was placed on record, NCDRC seemed satisfied with raising and rejecting the plea of res ipsa loquitur and holding that it is impermissible to assume that any sensible professional would intentionally commit an act which would result in an injury to the patient. In these proceedings for damages due to professional negligence, the question of intention does not arise. Unfortunately, the NCDRC did not even refer to the report of the MCI. In fact, a reference to the MCI report would have been sufficient to come to the right conclusion," the top court bench noted at this outset.
Referring to the MCI report, the Supreme Court bench noted that the MCI Ethics Committee sought the opinion of Experts- e Professors and HODs of AIIMS, New Delhi and KGMC, Lucknow, which held deficiency in service. After going through the expert opinions the MCI Ethics Committee had noted, "that Dr. Gurmit Singh has failed to exercise adequate medical competence in treating the patient" as there was large bowel perforation after the laparoscopic operation, and the doctor had failed to suspect the occurrence of complications despite following warning, signs/symptoms.
Therefore, referring to the findings of the MCI, the top court bench noted that, "So far as present proceedings are concerned, as they arise out of a claim for compensation on the basis of medical negligence, the opinion and findings of the MCI regarding the professional conduct of Respondent 1 have great relevance."
At this outset, the top court bench referred to the findings made by the erstwhile Medical Council of India and noted, "The above-referred findings of the MCI on the conduct of Respondent 1 leave no doubt in our mind that this is certainly a case of medical negligence leading to deficiency in his services. NCDRC, except referring to the general principles of law as laid down in the judgments of this Court has not attempted to draw its conclusion from the oral and documentary evidence available on record."
"Apart from the facts that clearly emerge from the report of the MCI, there is sufficient evidence to reiterate the same findings of deficiency. In the oral evidence, the following answers were elicited from Respondent 1 in the cross-examination which fortify the report given by the MCI," the bench further noted.
Holding the Laparoscopic surgeon Dr. Singh and the first Hospital guilty, the bench noted, "Having considered the matter in detail, we are of the opinion that the NCDRC has committed an error in reversing the findings of the SCDRC and not adverting to the evidence on record including the report of the MCI. The decision of the NCDRC deserves to be set aside and we hold that the complainants have made out a case of medical negligence against Respondents 1 and 2 and are entitled to seek compensation on the ground of deficiency of service."
However, the bench exonerated Dr. Mishra of the second hospital and observed, "The State Commission as well as the National Commission and even the MCI have not found Respondents 3 and 4 negligent in performing their services, and we are in agreement with such findings and therefore, confine our conclusion and directions to Respondents 1 and 2. To this extent, we reject the appeal of the complainant against all except Respondents 1 and 2."
Therefore, the bench directed Dr. Singh and the Hospital to pay Rs 25 lakh as compensation and stated in the judgment, "we are of the opinion that the interest of justice would be subserved if Respondents 1 and 2 are directed to pay to the complainants a total amount of Rs. 25,00,000 (Rupees Twenty Five Lakhs only) with interest @ 6% per annum from the date of SCDRC order as compensation. Respondents 1 and 2 will be entitled to adjust any amount already paid or deposited in favour of the complainants pending proceedings. The amount shall be deposited within a period of 6 months from today, failing which it shall carry an interest of 9% per annum."
To read the top court order, click on the link below.
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