A doctor not negligent for all that goes wrong

Bibekananda Panigrahi v. Prime Hospital Limited (NCDRC, 2015)

The complainant, Mr. Bibeknand Panigrahi took his father (the Patient since deceased) to Prime Hospital Limited (Hospital), where the Patient was operated by one Dr. Maheswar Sahoo (Doctor) for acute appendicitis on 05.06.2006, and the stitches were removed on 16.06.2006. Unfortunately, the surgical wound showed “gaping with pus discharge” and therefore the Patient was made to stay in the Hospital for a few more days, for dressing.  However, the wound got worsened and even after 15 days i.e. on 30.06.2006, the Doctor on through diagnosis and investigation was unable to detect the “cause of the infection” but assured the Patient that he would be cured soon.  

The Patient however developed a fecal fistula and hence in a day the dressing was to be done thrice and expensive injections had to be administered to the Patient.The Patient was diabetic and was already taking insulin however the dose of the same was increased considerably by the Doctor.Thereafter, the Patient was shifted to a nearby clinic and nursing home on the promise that the Doctor would visit the Patient, regularly.

On 03.08.2006, when the Patient was shifted to SCB Medical College, the Professor of Surgery opined that the Patient was a “victim of a mistake” committed by the Doctor post-operation/surgery.

As per the professor, many internal wounds were not taken care properly by the Doctor. Therefore, another surgery was carried out at the SCB Medical College, however the Patient died.

The son of the Patient filed a consumer complaint before the State Commission and prayed for compensation of Rs. 26, 50, 000/- from the Doctor and the Hospital.

The State Commission dismissed the complaint and hence the complainant approached the National Commission.

The case of the complainant is that the Patient had appendicitis and the same could have been treated by medicines however the Doctor and the Hospital performed the operation, which operation was however not carried out properly, being negligence on the part of the Doctor and the Patient.

The Doctor however put forth the following contentions to state that there was no negligence on the part of the Doctor:

• The Patient was actually a school friend of the Doctor and the Doctor took all care of the Patient,
• The Patient had sever gangrenous appendicitis, which had to be carefully operated and there was no lapse in the operation or post-surgical care by the Hospital and the Doctor,
• The gaping wound occurred because of the delayed healing of the wounds of the operation,
• It was Patient’s decision to take discharge from the Hospital and go to SCB Medical College.

The National Commission, on perusal of the medical record on the file, observed as follows:-

• The patient had high fever and there was a lump in right iliac fossa and therefore a decision was taken for appendectomy,
• As per the operative notes, the abdominal wall was opened by right para-median incision (this refers to a surgical incision, especially of the abdominal wall, close to the mid-line), and there was pus in the peritoneal cavity. The Appendix was gangrenous. The base of the appendix was tied up after removing the gangrenous appendix. There was pus in spaces and even after removal of stitches, there was gaping of wound with pus discharge because of which the Patient developed fecal fistula,
• At the time when the Patient was admitted, the Patient had 102 degree (F) temperature, 210 mg% of blood sugar and 91 mg blood urea and 4.8 mg% Creatinine – these values are of very high importance.
• The Patient had hypertension and had been on medication for the last 10 years.

The Judgment

1.        Doctrine of Res-ipsa loquitor (meaning, things speak for themselves): 

        The court did not apply this doctrine because in the instant case, the development of fecal fistula was a sequel gangrenous appendicitis and the fact that the Patient was diabetic is the additional cause for poor healing of wound.

2.         Reliance on Medical Literature:

• Appendectomy is one of the commonest procedures performed in surgical practice
• The post – appendectomy faecal fistula formation, though it is a rare complication, is associated with significant morbidity and
• Most of the fecal fistulae respond to the conservative treatment in the absence of an underlying pathology and distal obstruction.

3.         Reliance on doctrines and principles by the Supreme Court: 

• Jacob Mathew’s Case (SC, 2005): A medical practitioner when faced with a medical emergency tries his best to redeem the patient out of suffering and the Doctor gains nothing in by acting with negligence or by omitting to do an act.
• Martin F. D’Souza’s Case (SC 2009): A medical practitioner will not be liable just because things went wrong as chance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference to another – he would be liable only if the conduct fell below that of the standards of reasonable competent practitioner in his field.
• Roe v. Ministry of Health (UK, Lord Denning): We would be doing a disservice to the community at large if we were to impose liability on hospitals and doctors for everything that happens to go wrong.
• Indian Medical Association v. V.P. Shantha (SC, 1996): Court / Consumer Forums should keep the above facts in mind or else it would be disservice to the public and doctors should not be harassed merely because their treatment was unsuccessful or caused some mishap which was not necessarily due to negligence.

Hence, the death of the Patient occurred due to multiple factors and there was no negligence on the part of the Doctor or the Hospital either during the surgery or the post – surgery care / treatment. The Appeal of the son of the Patient was hence, dismissed with the following words:-

“The Doctor / Patient relation is at a crossroads. Some patients want the doctor calling all the shots, deciding the best treatment path to follow. Patient misses the trust and warmth found in the personal bond with a caring, competent physician. Boundaries in the doctor – patient relationship is an important concept to help health professionals navigate the complex and sometimes difficult experiences between patient and doctor where intimacy and power must be balanced in direction of benefiting patients”

-J.M Malik, Presiding Member and Dr. S.M Kantikar, Member

The NCDRC has formulated its judgment based on a more elaborate piece of literature written by Mr. Kent Bottles, MD titled “Doctor Patient Relationship for 21st Century”