New Delhi: Through a recent judgement, the Delhi State Consumer commission directed GM Modi hospital ( Now, Max ) and its surgeon to a pay compensation of Rs 21 lakh Plus interest to patient after holding them guilty of negligence and overcharging by showing unnecessary surgeries in the bill
The case concerns deceased woman, who had recurrent pain in her stomach and visited G.M. Modi Hospital for treatment where she was diagnosed to be suffering from Muchocete of gall bladder with Mirizzi syndrome.
She was admitted in the Hospital on 05.02.2006 and on 06.02.2006 and was operated for Laparoscopic Cholecysteotomy Mucocete Gall Bladder Type I with multiple Fibroid Uterus. However, as per discharge summary the patient had undergone Laparoscopic Cholecystectomy and common bile duct exploration with laparoscopic assisted Vaginal Hysterectomy. Reason for this operation as reflected in the discharge summary, according to the complainant, it was not clear as there was apparently no evidence that there was a block in CBD requiring this operation/surgery.Besides, no consent was obtained, the complainant alleged
The patient after discharge could not fully recover and was in constant pain. She was however recommended only pain killers to manage her pain. She was then taken to the Dr. RML Hospital where, after CT scan, it was diagnosed as Multiple Tumors. Finally, at the Rotary Hospital Cancer it was detected that the patient, since deceased, was suffering from Metastatic Adenocar Cinoma which was advance stage of cancer and accordingly she was administered Chemotherapy.
The complainant alleged that the Modi Hospital despite having done a lot of tests and investigation involving a lot of expenditure could not detect the ailment the patient was suffering from, thus have been severally deficient in the discharge of their duty. In particular the complainant made an allegation that Dr Panigrahi ( Surgeon )and Dr. Malik ( MS and Orthonecian) were grossly negligent in due discharge of their duty. It was also alleged that the organs removed during surgery were not shown either to the complainant or to her kith and kin, aggravating their guilt and negligence and no consent was taken for the operation .
Further, allegation was made by the complainant that the organs removed are required to be sent for Hystopathological Examination but the opponent parties had sent only Uterus for examination and not the gall bladder. The contention of the complainant is that the gall bladder at the time of operation got punctured and the biles stored in the gall bladder splitted inside causing irreparable damage to the organs.
Since the gall bladder was removed in parts, the same was intentionally not sent for Hystopathological examination. Even after surgery of gall bladder, pain in the abdomen was persisting. The allegation of the complainant is that had the visera (gall bladder) been sent for Hysotopathological examination the long term post-operation follow-up and treatment could have been different which could have restrained the development of Metastic-Carcinoma (i.e. spread of cancer). In its ultrasound report it was mentioned that there was a large mass in the gall bladder which was suggestive of the fact that gall bladder was not removed properly.
The complainant demanded a sum of Rs. 50 lakh as compensation with interest of 24% per annum and a sum of Rs. 33,000/- towards the litigation. The plea was first dismissed by the forum, however, after an appeal with the NCDRC, the case was sent back to the forum to decide on.
In their defence before the court, both the surgeon and the hospital ( through the MS) denied any wrongdoing. The surgeon stated that no allegation of late detection of cancer can be levelled against him as the Pre-operative tests (U/S, CT, MRCP, LFT) are not showing any evidence or suspicion of malignancy in gall bladder. It appears that the complainant was detected of liver secondary cancer after approximately one and half year of operation.
The complainant had underwent Hysterectomy and salpingo-opherectomy and not oopherectomy. However, as in the CGHS, packages for salpingectomy alone is not available, they have charged for salpingo-opherectomy without doing oophorectomy, the doctor told the council in rejoinder
The case had come before the Delhi Medical Council, which analysed the entire case and held both the doctor and the hospital guilty
The Delhi Medical Council is of the opinion that the surgeon Dr. A.K. Panigrahi has failed to perform his duties with reasonable degree of skill, knowledge and care required for such clinical situations. Hence, Dr. A.K. Panigrahi’s (DMC Registration No. 20432) name is to be removed from the State Medical Register for a period of 12 weeks. During this suspension period, he is barred from practicing medicine and directed to attend at least 15 CME programmes to update his knowledge and submit the compliance report to the Delhi Medical Council. This temporary removal of name from State Medical Register shall become effective after 30 days from the date of this Order.
Further, the hospital has failed to provide adequate manpower comensurating to the services it provides to the public. The management of the hospital has also not responded well to the needs of various services. Directorate of Health Services may be informed to review the registration of G.M.Modi Hospital and take immediate steps so that all norms are complied with.
The MCI Ethics committee in appeal also discussed about the case in detailed and arrive their unanimous decision that there is medical negligence on the part of Dr.A.K.Panigrahi and also complicity of the hospital. It upheld the conclusion given by the Delhi Medical Council.
The MS of the hospital directing the responsibility to the surgeon stated, that he had no role in the matter and as soon as DMC order came, they relieved the surgeon.
After going through all the record in place, the forum held the doctor guilty of negligence
The present case is not a case of surgery or a case of transplant of limbs and organs in human body. It is allegedly a case where as found by the State Medical Council the OP-5 could not make proper and timely assessment or evaluation of the ailment the patient was suffering. Had proper assessment or adequate measures were adopted, the ailment which though existed but could not be detected would have been detected and preventive or remedial measures or steps could have been ensured to save the life. Besides, the OP-5 was found to be negligent in not bothering about the Histopathological report, an important document specially when one suspects, as is the case, malignancy. Facts in this case speak for themselves, covered by the Principles of Res ipsa loquitur, which principle is a rule of evidence which in reality belongs to the law of torts. Inference as to negligence may be drawn from proved circumstances by applying the rule if the cause of the accident is unknown and no reasonable explanation as to the cause is coming forth from the defendant.
….Dr. A.K. Panigrahi has been found highly negligent in not sending the gallbladder for histopathological report. It may be mentioned here that the plea of Dr. A.K. Panigrahi that he gave all the removed parts to the relatives of the patient is falsified by the fact that the sample of ovary has been sent for hystopathological examination whereas no such proceedings were conducted in respect of gallbladder.
The court also held the hospital guilty of the wrong procedures in the bio
Bowel resection has been shown to have been done only for the purpose for raising bill. Similarly oopherectomy (removal of ovaries) was shown to have been done for the purpose of raising bills. In a subsequent report, as discussed above, ovaries of the patient were found intact in an MRI Scan. Medical Council of India has thus rightly held that there was complicity between Dr. A.K. Panigrahi (OP-5) and G.M. Modi Hospital (OP-7). Both have been found guilty.
The court further noted
- G.M. Modi Hospital (OP-7) washed its hands off and tried to wriggle out of the ‘mischief’ committed by it. It showed surgeries having been done which were never done. There is no dispute with the proposition that the profession of a doctor is the noblest one. Only for the purpose of raising bills, unnecessary surgeries have been done and certain surgeries have been shown to have been done which were not done.
- In the present case while removing the gall bladder, hysterectomy (removal of uterus) was also done. Husband of the complainant had no option but to accord consent. Dr. A.K. Panigrahi without informing and without consent, carried out CBD exploration. Dr. A.K. Panigrahi again without consent carried out lap assisted small bowel resection. He also fraudulently mentioned to have carried out salpingo oophorectomy (removal of fallopian tubes and ovaries). It was done to raise bill with the connivance of the OP-7 hospital.
Keeping the literature details and facts and circumstances of the deceased, and other necessary and essential factors in consideration, the Delhi State Commission asked to pay compensation of Rs 20 lakh to the complainants for the suffering, mental pain and agony caused. Additionally, an amount of Rs 1 lakh is awarded as litigation expenses and other miscellaneous charges.