Ovary Removal of Minor: Urologist, Hospital, IMA AP Branch told to Pay Rs 11 Lakh
Telganana: Ruling in favour of 13-year-old complainant, a Hyderabad Consumer Forum directed a senior urologist, the Indian Medical Association (AP) and Surya Nursing Home - all held jointly responsible - to pay a sum of Rs 6,00,000 with an interest of nine per cent per annum from the date of complaint in 2008, and Rs 5,000 towards costs.
Case concerns that of a minor girl suffering from pain in abdomen since menarche who consulted Ch.Ravinder Rao , urologist on 15-09-2006 as she was admitted in Surya Nursing home where she was undergone Ultra Sonography of abdomen. The report was normal Uterus in size and shape and right ovary normal, left ovary,Heterogenous mass left T.O. region. Relying on the USG report, the urologist performed surgery of exploratory Laparotomy. During the laparotomy, appendecectomy was done and the complainant was assured that there would be no pain in the abdomen.
But the complainant had developed pain in abdomen again after a month. As such she consulted the doctor on 16-10-2006 due to which she was re-admitted at the nursing home on 20-10-2006 and referred to another Radiologist for USG abdomen. The report was suggestive of Bicornate Uterus with Heamatometra in Left Horn, Rudimentary horm/imperforate. Both ovaries are normal. On seeing the report the doctor stated that complainant would be relieved of pain by draining the blood collected in left horn by passing Uterine sound and he also said that the said procedure would hardly take 10-15 minutes. The doctor obtained exclusive consent for passing Uterine sound but converted the procedure into Laparoctomy which lasted for two hours. However, again after a month complainant had same problem and when the High Resolution Real time Ultra Sonography was performed on 10-11-2006, the left ovary was not visualised. The complainant alleged that the doctor instead of providing relief from the ailment he removed the vital reproductive organs i.e. left tube and ovary.
The family further alleged that the patient being minor girl of 12 years, should have been referred to a gynaecologist for a diagnostic and curative technique of Laproscopy /Hysteroscopy which is an advance and preferred mode of surgery in young women below 35 years of age, in which the long incision scars could have been avoided. The complainant and parents were not informed about this alternative technique. The opposite party doctor advised the complainant to go for Hysteroscopy after unauthorized removal of left ovary on 20-10-2006. With this complaint the family demanded a compensation of Rs 10 lakh.
The doctor and the hospital resisted the claim of the complainant stating that there is no negligence on their part as the complaint is not maintainable. Due to severe abdominal pain, the complainant was admitted in the hospital by Ultra Sonography of abdomen and after going through the findings of the report the doctor performed exploratory Laparotomy in Surya Nursing Home, with the assistance of other qualified doctors i.e. Dr.Pranathi MD DGO and Dr.Vishnu Vardhan Reddy who is MBBS doctor .
Dr Rao obtained exclusive consent for passing Uterine sound but converted the procedure into Laparotomy which lasted for two hours. All the said anomalies are recorded in the case sheet after opening the abdomen. Taken utmost care prior to during and after operation, which was explained in detail to the father of patient and other attendants about all findings, their consequences and necessity of consulting a Gynecologist for rectification of anomalies. Even Dr.Pranathi also advised the same. After taking consent from father of complainant Laparotomy was done Uterus enlarged bicornuate, left horn tense thick, remains of left ovary were small necrotic? Gangrenous, Necrotic left ovarian tissue excised after explaining and obtaining consent from parents of complainant. After the operation all the findings were explained to parents of complainant and advised to go to Hyderabad for rectification of congenital anomalies and referred to Dr.Sashikala, MD Hysterscopic surgeon. Finally, they contended that there is no negligence on their part as they have taken every possible medical care in providing treatment to complainant.
IMA in its defence pointed out Dr Rao is a member of the Association and governed by IMA of A.P.State Professional Protection and Welfare Scheme and was unnecessarily making the Association as party though not concerned and the IMA rules and Bye Laws are limited one and the policy is also limited one which fact is not known to the complainant. If there is any wanton negligence on the part of the doctor, the Association will not come to his rescue. Even otherwise the petition is not maintainable in law or on facts of the case. If the Association will become parties all over India and this way of thinking and the concept of the complainant is not correct. It is ridiculous to say that the Association has been made party for each and every default of every individual person or action on behalf of some hospital who is the Member of the Association. In case this type of frivolous petitions are filed, the Association will not extend any cooperation to the doctor, hence prayed to dismiss the impleading of the Association as opposite party.
The court after going through the arguments and submissions observed,
- The ovary, though taken out was not sent for Histopathology- Quoting the national commission in a previous judgement that stated "it is mandatory to produce the histopathological report by the doctor to support his diagnosis about the status of left ovary”- the forum held that In the absence of pathology the probable seat of pain/dysmenorrhea was only Haematometra in the left horn of the Bicornuate Uterus, as there was no facility of Laproscopy or Hysteroscopy opposite party no.1 should have referred the complainant to a higher centre.Instead of that the doctor again performed Laparotomy
- Appropriate Consent for Surgery was not taken-the consent was only for passing Uterine sound, but not for performing ‘Laparotomy’ and for removal of left tube and ovary”. Quoting the National Commission which earlier held that “the consent must be informed and not blanket in nature before starting surgical interference”, the forum observed that in the instant case the removal of ovary and tube was not informed by the Doctor after the two surgeries performed by him.
- Doctor was not qualified Urologist- The forum observed that doctor was not a qualified Urologist but stated that he worked in Urology department in Osmania University, Hyderabad for 5 years and On the basis of his experience claimed as Urologist since earlier there was no super specialty degree. The forum held that the doctor is deficient in service by claiming himself to be a Urologist.
Holding a deficiency in service, the court held all the parties jointly and severally liable and directed to pay the complainant a sum of Rs.6,00,000/- towards compensation with interest @ 9% per annum from the date of filing of the complaint i.e.10-11-2008 till realization, and Rs.5,000/- towards costs within one month
Attached is the judgement below