Surgical gauze left inside abdomen during hysterectomy: Hospital, Gynaecologist slapped Rs 12 lakh compensation
Medical Negligence
Coimbatore: Holding a Coimbatore-based gynaecologist and a private medical facility liable for medical negligence for leaving a surgical gauze inside during a hysterectomy, the District Consumer Disputes Redressal Commission (DCDRC), Coimbatore, has directed them to pay Rs 12 lakh as compensation to the patient.
It was observed that the patient suffered major post-operative complications, including pelvic abscess, colovaginal fistula, and had to undergo multiple corrective surgeries.
"The 1st and 2nd opposite parties (doctor and hospital) are directed a) to pay the complainant a sum of Rs. 12,00,000/- (Rupees Twelve Lakhs Only) as compensation for the mental agony, emotional trauma and financial loss caused by their negligence and deficiency in service b) to pay a sum of Rs. 5,000/- (Rupees five thousand only) towards the cost of proceedings. All the above payments shall be made within a period of one month from the date of receipt of this order, failing which the opposite party shall be liable to pay interest at the rate of 9% p.a towards the above said total amount till it is realized. The complaint against 3rd opposite party is dismissed," ordered the consumer court.
Background:
The history of the case goes back to 2018 when the complainant/patient consulted the treating gynaecologist at the treating private medical facility with a complaint of severe abdominal pain.
After examining the patient, the treating doctor diagnosed that she was suffering from uterus and hernia-related problems and advised her to undergo a hysterectomy. Based on the doctor's advice, the patient got admitted to a Hospital in Coimbatore, where the hysterectomy, a surgery to remove the uterus, was performed. The patient was discharged the next day.
However, the patient continued suffering persistent abdominal pain. It was alleged that even though the complainant repeatedly approached the doctor for follow-up treatment, she was asked to take painkillers.
Her condition worsened, and after a few months from when the hysterectomy was performed, she developed heavy bleeding mixed with stools. Following this, she promptly sought treatment at ESIC Medical College and Hospital, Coimbatore, and in its records, the hospital noted the presence of a gauze-like foreign material near the vaginal vault. This was removed at the hospital, and later the doctors there referred the patient to Stanley Hospital, Chennai for advanced treatment.
The patient had to undergo multiple corrective surgeries at the Chennai hospital for deep organ surgical site infection and colovaginal fistula. Later, she underwent another surgery at another hospital.
Filing the complaint before the Consumer Court, the patient sought Rs 50 lakh as compensation for alleged prolonged physical suffering, mental agony, emotional trauma and financial hardship arising from the medical negligence during the hysterectomy.
On the other hand, the treating Gynaecologist and medical facility, where the patient had consulted the doctor, claimed that there was no medical negligence on their part. They argued that the complications in the patient had resulted from the erosion of a Prolift mesh, which was implanted during a surgery back in 2007.
They further submitted that the patient had given informed consent after being informed of the surgical risks. They also relied on the surgical records and the report of the MRI scan, which allegedly did not reveal any retained foreign body.
Meanwhile, the private hospital where the surgery was conducted submitted that it had only provided the facilities, including the operation staff, nursing staff and other infrastructure. According to the hospital, the surgery and the treatment had been conducted entirely under the care of the treating gynaecologist.
Observations by Consumer Court:
While considering the complaint, the consumer court observed that it is well settled that a medical practitioner is required to exercise reasonable skill and care while rendering treatment.
It noted, "Mere occurrence of a complication or an unsuccessful outcome does not by itself establish negligence. However, where the facts proved on record disclose circumstances which ordinarily would not occur in the absence of negligence, the principle of res ipsa loquitur may become applicable and an inference of negligence may arise from the facts themselves."
The Commission took special note of the records of ESIC Medical College and Hospital, Coimbatore. Those records showed that when the complainant was examined and treated in March 2019, a gauze-like structure was found adherent near the vaginal vault and was removed. The records further refer to infection, pus discharge, pelvic abscess and retained foreign body following hysterectomy. These records were prepared by an independent Government institution during the course of treatment, and there is no material on record to discredit their contents, noted the Commission.
Further, the consumer court also took note of a certificate dated 06.04.2019 issued by the Department of Surgical Gastroenterology, Government Stanley Hospital, Chennai, which recorded that the complainant was diagnosed with Deep Organ Surgical Site Infection and Colovaginal Fistula following Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy (TAH & BSO).
"The certificate establishes that the complainant developed serious post-operative complications requiring specialized treatment and further management. The said certificate, read along with the ESI Hospital records regarding the discovery and removal of a gauze-like foreign material from the operative site, lends support to the complainant's case regarding the complications that arose following the surgery performed on 16.11.2018," the Commission observed at the outset.
It also noted that the MRI scan and subsequent records of Government Stanley Hospital, Chennai further revealed pelvic abscess and colovaginal fistula for which the complainant underwent major corrective surgeries and prolonged treatment. "The records show that the complainant had to undergo repeated hospitalization and surgical intervention on account of the complications that developed after the surgery performed on 16.11.2018," the Commission observed.
Referring to the argument that the complications resulted from the complainant's history of earlier surgeries and mesh erosion from a prolift mesh implanted in 2007, the Commission noted that even though the complainant had undergone previous surgeries and mesh erosion is recognized medical complication, the medical records also showed that a gauze-like foreign material was found and removed from the operative site after the surgery performed by the treating gynaecologist.
"The development of infection, pelvic abscess and fistulous communication thereafter cannot be ignored," noted the DCDRC.
"The contention of OP1 and OP2 that the ESI records merely refer to a "gauze-like structure" and therefore do not establish negligence cannot be accepted. The records of ESI Hospital show that a gauze-like foreign material was found adherent near the vaginal vault, which was the operative site of the surgery performed by OP1. Gauze is not a material naturally found within the human body. In the absence of any intervening surgical procedure, the presence and subsequent removal of such material from the operative site is a significant circumstance. When considered together with the subsequent infection, pelvic abscess and colovaginal fistula, the records raise a strong inference that surgical material had remained at the operative site following the surgery. The use of the expression 'gauzelike structure' in the ESI records does not affect the evidentiary value of the clinical findings recorded therein. The further contention that the MRI scan did not specifically reveal the presence of a foreign body also does not advance the case of OP1 and OP2, since the subsequent clinical findings recorded during treatment carry greater evidentiary value," it held.
The DCDRC further observed that the enquiry conducted by the Joint Director (Medical and Rural Welfare), Coimbatore, also recorded that there was a possibility that used cotton gauze had not been removed during treatment. "Though the enquiry report is not conclusive proof by itself, it lends support to the complainant's case and corroborates the medical records," observed the Commission.
"On an overall consideration of the evidence, this Commission is of the view that the complainant has established that a gauze-like foreign material was found and removed from the operative site following the surgery performed by OP1 and that the complainant subsequently suffered pelvic abscess, colovaginal fistula, repeated hospitalization, multiple surgeries, prolonged treatment, pain and suffering. The medical records establish a direct and proximate nexus between the retention of foreign material at the operative site and the subsequent development of pelvic abscess and colovaginal fistula. While the complainant's pre-existing mesh erosion condition is noted, the sequence of events — namely, the discovery and removal of foreign material, the discharge of pus, the formation of abscess and the development of fistula — is more consistent with a postsurgical foreign body reaction than with mesh erosion alone. The facts and circumstances of the case attract the principle of res ipsa loquitur and establish negligence and deficiency in service on the part of OP1," it further noted.
It was observed by the Commission that the private medical facility is the hospital through which the treating doctor examined and treated the complainant before and after surgery and the pre-operative consultation, diagnosis and postoperative follow-up had been conducted there.
"OP1 being a doctor attached to and operating through OP2, the latter is the service provider within the meaning of Section 2(42) of the Consumer Protection Act, 2019. The negligence of OP1 in the course of rendering services through OP2 renders OP2 jointly and severally liable," it held.
However, the Commission dismissed the complaint against the treating hospital where the surgery was conducted. "...the materials on record only establish that the surgery was performed at its hospital under the care of OP1 and that OP3 provided hospital facilities. No independent act of negligence or deficiency in service on the part of OP3 has been established by acceptable evidence. Therefore, no liability can be fastened upon OP3," it held.
Accordingly, the District Consumer Court directed the doctor and treating facility to pay Rs 12 lakh compensation to the complainant/patient.
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/2026/07/31/dcdrc-coimbatore-362465.pdf
