Splenectomy Without Written Consent: Doctor told to Compensate Rs 2.25 lakh to Patient

Madurai: Holding medical negligence in removal of the spleen of a patient, the Madurai District Consumer Disputes Redressal Forum directed a doctor attached to Gurumithrren hospital to compensate an amount of Rs 2.25 lakh to the patient.

The case relates to the patient, M Beemarajan, a resident of Pandiyan Nagar Madurai, who alleged that the doctor did not take written consent from him prior to the surgery. He also alleged that the doctor is not qualified to perform Spleenectomy surgery and removed the spleen without any necessity.

Beemarajan, the patient in 2008 had approached Dr S Karthick experiencing body pain and tiredness. and was diagnosed with jaundice. When the patient's condition did not improve despite different kinds of treatment given to the patient, the doctor advised Beemarajan to undergo surgery.

Following the doctor’s advice, Beemarajan got admitted in Ponni Hospital, Narayanapuram, Madurai and operation was performed upon him on 22.05.2008 and he was discharged on 30.05.2008.

The doctor has contended that the patient’s CT scan report revealed enlarged spleen. As his final diagnosis was “Uncojugated Hyperbilirubinima and Hyperspleenism”, the doctor suggested spleenectomy.

Claiming that Dr.Sivasubramanian has done the said surgery, not him, the doctor said, “The surgery was done after obtaining his consent Spleenectomy has accepted procedure for Hypersplenism. Therefore there is no medical negligence.”

The patient claimed that he incurred an amount of Rs.1,90,000/- towards medical expenses at  Gurumithrren hospital whereas stating it false, the doctor said that the patient might have incurred Rs.60,000/- including room rent, operation charges etc.

After hearing both sides, the court stated, “Every surgery must be performed with the written consent of the patient or guardian of the patient if the patient is minor. The consent must be “informed and valid consent”. In this case, opposite party has informed complainant orally stating that operation has to be performed in order to reduce bilirubin in the blood.”

While examining the reports prior to the surgery which said, “Spleen and adrenal show normal size. Shape and Signal pattern – No evidence of focal mass lesion seen”, the court added,

“Therefore the spleen of the complainant was normal prior to the surgery. The opposite party has stated that spleen was enlarged and hence Spleenectomy was suggested by opposite party. The opposite party has not filed any evidence to show that his spleen was enlarged.”

Stating that there is no evidence that the hospital had clearly informed the patient that the entire spleen had to be removed, the bench observed,

“Consent given for a surgery could not by inference be taken as consent for removal of Spleen…. No document had been produced by opposite party side with regard to the consent of the complainant. The written consent of patient would be usually available with the patient’s case sheet but in this case, opposite party has not taken any steps to produce the case sheet of the patient. Hence this forum concludes that written consent of complainant was not obtained prior to the surgery.”

On the allegation that the doctor was not qualified to perform Spleenectomy surgery, the bench asserted,

“The opposite party has stated in the written version that the surgery was done by Dr.Sivasubramanian M.S., F.I.C.S and not by Dr.S.Karthick (opposite party). The patient’s case sheet of Ponni hospital has not been produced for the reason best known to opposite party. As the said surgery was done in Ponni hospital under the supervision of opposite party, opposite party has to prove that the surgery was done by Dr.S.Sivasubramanian and not by him.”

The court also observed that the doctor did not sent any reply  to the legal notice by the patient, denying the said allegation. The overall circumstances of the case lead to conclude that the surgery was done by Dr.S.Karthick.

The bench noted, “Dr.S.Karthick has not completed MRCS course at the relevant time and hence he was not qualified to perform the Spleen removal surgery.”

Adding to that the bench said, “As the opposite party has failed to explain as to why removal of Spleen is warranted, this forum is constrained to conclude that the removal of Spleen by opposite party is unwarranted.”

“The opposite party failed to get written consent from complainant prior to surgery. The opposite party is not qualified to perform Spleenectomy surgery. The opposite party has removed the Spleen of the complainant without necessity. Even after the removal of Spleen, the bilirubin in the blood has not come down. The complainant did not recover from the ailment even after surgery,” the bench concluded,

“All the above circumstances clearly prove the medical negligence of the opposite party. Hence this forum hold that complainant proved the medical negligence of opposite party.”

“The opposite party is directed to pay Rs.75,000/-to the complainant towards operation charges and medical expenses etc incurred unnecessarily. The opposite party is directed to pay compensation of Rs.1,00,000/- (Rupees One Lakh only) to the complainant with 6% interest from the date of complaint till realization for loss of Spleen and permanent disability. The opposite party is also directed to pay compensation of Rs.50,000/- to the complainant for mental agony, physical strain etc. The complainant is also entitled to get Rs.3,000/- as cost from the opposite party.”

 Attached is the judgement below