POST-OPERATIVE CARE

13-57.1 Post-operative care-Lack of-Excess loss of blood during operation causing death-Negligence held-Compensation of Rs. 7 lac awarded- The de- ceased Arvind K. Himmatlal was operated upon his left hip by Dr. K.T. Dholakia on 19.8.1992 in Bombay Hospital but died next early morning. It was alleged that there was considerable delay in performing the operation, and the patient was having continuous bleeding from the operation wound, but no senior doctor attended on him and ultimately he died due to blood loss. The relatives were not fore-warned to keep sufficient stock of blood in the event of emergency, and no outside doctor of their choice was permitted to treat the patient. The allegations made in the complaint duly supported by an affidavit was not controverted at all by the opposite party, and the State Commission held that the Hospital was negligent in rendering proper post-operative care, and awarded Rs. 7,00,000/- as compensation with interest at the rate of 12% p.a. from the date of complaint till realisation. [Heirs and LR's of the deceased Arvind Kumar Himmatlal Shah v. Bombay Hospital Trust, Complaint No.20 of 1992 decided on 10.6.1992 (Mah. SCDRC).]

13-57.2 Post-operative care-Charging of fee for-Not a consumer dispute- The charging of Rs. 40,000 for post-operative care and treatment in a cardiac surgery case, the National Commission found it to be clearly unreasonable. But, however improper it may be, the demand and acceptance of an exorbitant fee cannot be deemed to be deficiency in service and hence, it is not for the consumer forums to adjudicate on the question whether the consideration'charged was reasonable. [Dr. Sudhanshu Bhat- tacharya v. B.S. Hegde, 1993 (3) CPR 414 (Mah. SCDRC).]

13-57.3 Post-operative care-Malignant glaucoma-Loss of eyesight after surgery-No negligence- The complainant was operated for malignant glaucoma, but her eye-sight did not improve. It was alleged that this occurred due to the negligent manner in which the operation was performed and lack of post-operative care.

After considering all material on record the State Commission held that the complain- ant failed to discharge the heavy onus of establishing negligence or deficiency and failed to examine any other specialist who subsequently treated her. The fact that the doctor refunded the expenses by means of a cheque is a circumstance which itself does not go against him. Complaint dismissed. [Asha Rani v. Dr. Rohit Grover & Ors. , 1996 (3) CPJ 259 (Chd.-UTCDRC).]

13-57.4 Post-operative care-Caesarean operation bleeding after surgery- new plea by complainant-Not accepted-Negligence not proved- the complain- ant's wife underwent a Caesarean operation, but allegedly due to lack of post-operative care she died. It was contended that the uterus should have been removed to stop the bleeding but the doctor failed to do so. The State Commission held that this argument was not put forth in the complaint and before the District Forum. It was for the first time that it was argued and therefore it refused to accept this point. It also held that blood was arranged before the operation, and upheld the decision of the District Forum of dismissing the complaint. [M. Subramani & Ors. v. Christu Jothi Hospital & Anr., 1998 (3) CPR 428 (NCDRC).]

13-57.5 Post-operative care-Eye surgery-Lack of proper care and treatment following surgery-Patient 7 year old boy in a boarding school-Principal of Boarding School and ophthalmologist held negligent for not looking after properly-Compensation of Rs. 50,000 awarded against the pricipal of school and doctor-The complainant's 7 year old son, studying at St. Andrews School, Ranchi as a boarder injured his right eye and was operated upon at Kashyap Eye Hospital. The following day he was handed over to the parents by opposite party No.1, who had come with the child to Calcutta by train. It was alleged that it was negligent to discharge the boy and bring him back to Calcutta in a most uncomfortable and cruel manner, with blood oozing from his eyes, despite further treatment he still has diminution of vision of his right eye.

The State Commission held that the school authorities should have informed the parents and taken the initiative to treat him at a proper eye hospital. The poverty of the boy's parents was too well known to the Principal of the School and the boy was very cruelly treated to meet the present pathetic condition. Both the Principa1 and Dr. Kashyap were held negligent and asked to jointly and severally pay a sum of Rs. 50,000 as compensation. [Lax mi Joy Prasad v. Dr. Cameroon & Ors., 1998 (1) CPJ 336: 1998 (2) CPR 450 (WB SCDRC).]

13-57.6 Post-operative care-Fracture of femur-Death on the same date of operation-Case of pulmonary emoblism resulting in cardiogenic shock-No negligence- The complainant's husband was operated for fracture femur, but died same evening. It was alleged that this occurred due to lack of post -operative care and excessive bleeding. Essential pre-operative checkup like clotting-time of the blood, E.C.G. etc. was not carried out, nor the opinion of the physician was obtained.

The State Commission on basis of material evidence held that the pathological tests were carried out by a qualified person, there was no proof even on post-mortem that there was excessive loss of blood. No accumulated blood or haematoma was found in the operative wound during post-mortem examination. In view of the history that the deceased was hale and hearty, no detailed coagulation tests were warranted. Duty doctor was present to take care during the post-operative period. The medical literature fortifies the contention of opposite party No.2 that this was a case of pulmonary embolism which resulted in cardiogenic shock. Such embolism may occur when patient has undergone hip operation. Complaint was dismissed. [Smt. Archana & 4 Ors. v. Chaudhari Trust Hospital & Ors., 1998 (1) CPR 556 (Mah. SCDRC).]

13-57.7 Post-operative care-Orthopaedic surgery-Fracture of femur- Symptoms of gangrene spreading rapidly, but no step taken to control- Vascular surgery and amputation of leg-Negligence, held-Rs. 1,50,000 awarded as compensation-The operation was carried out on 3.7.1996 by a team of Orthopaedic surgeons. The complainant has alleged that after a few hours of the operation, her right toe turned blue. The complainant continued to complain to the doctors regarding increase of the pain of the operated leg but there was only assurance and reassurance given by the doctors concerned. She also suffered from vomiting but it was brought under control after some time. It was recorded on the discharge slip "right leg had bluish discolouration below the knee. The skin of the toes shrivelled and red. Temp over the limb and toes... ADS done." The complainant was taken to the Christian Medical College Hospital, Ludhiana and reached there in the morning of 10.7.1996. It was informed to husband of the complain- ant, that her right leg was to be amputated because she was having gangrene. Therefore, the right leg of the patient was amputated below knee on 13.7.1996 and since it was not healing another amputation was carried out on 17.7.1996 up to the joint of the knee. Dr. Mam Head of Orthopaedics Department, C.M.C., Ludhiana has opined that the patient should be treated within 6 hours of the vascular impairment and if there is delay between 12-24 hours, the gangrene is almost certain. Held: In this case there was deficiency in the post-operative care of the patient at Sector 16, Hospital, Chandigarh. Thus, the deficiency on the part of the staff of the hospital of Sector 16 is well established. It is held that respondents No.1& 2 only are liable to pay a sum of Rs. 1,50,000/- as compensation for the neglect of the patient during post-operative period. (Sukhwarsha Rani v. General Hospital, through its Medical Supdt. & Ors., 2000 (1) CPR 337 (Chd.-UTCDRC)] 13-57.8 Post-operative care-Surgery-Laparoscopic Cholecystectomy-Re- moval of gall bladder-Biliary drainage-Endoscopic retr9grade cholangio pan-creatography (ERCP) test not done-Death of patient-Negligence held for deficiency in post-operative care- The deceased, wife of complainant, suffering from pain in abdomen underwent operation and her gall bladder was removed from its fundus in liver by laparoscopic cholecystectomy. After repeated operations, there had been biliary drainage, but the opposite party did not advise the urgently required ERCP test and ultimately the patient died. Held: We do not hold opposite party No. I and No.2 responsible for the death of the patient Smt. Pramila Kohli but we hold them (opposite parties Nos. 1 and 2) responsible for deficiency in post-operative care after laparoscopic cholecystectomy which required urgent ERCP test, due to excessive biliary drainage for reasons best known to them, none of the two, advised urgent ERCP test drastically compromising patient's life. We, therefore, direct opposite parties Nos. 1 and 2 jointly and/or severally to pay to the complainant a compensation of Rs. 50,000/- for deficiency in post-operative care after laparoscopic cholecystectomy and to pay Rs. 5,000/- as proceedings expenses. (N.K. Kohliv. BajajNursingHome, 2000 (2) CPJ 308: 1999(2) CPR 79 (MP SCDRC)]

13-57.9 Post-operative care-Surgery-Patient not shifted to ICU immediately after operation, not proved to be cause of death-Negligence not held-A decision was taken by the doctors in the best interests of the patient to provide her with best possible attention and personal care of special nurses and the doctors and not to keep the patient in ICU. The patient's condition after the first few days of the surgery was stable. Unfortunately, the condition of the patient deteriorated. Thereafter, the patient was taken to ICU. However, in spite of the best efforts, the patient died. The State Co1nmission has examined the facts in extenso and has found that there was no lack of care and attention on the part of the doctors and the nurses in treating the patient. What has been highlighted is that the patient was not immediately taken to ICU after the operation. But, it has not been proved in any way that this had led ultimately to the death of the patient. Moreover, a conscious decision was taken to keep the patient in her cabin having regard to the stable condition of her at that time. The decision was taken after taking into consideration various factors. It cannot be said that the decision was taken arbitrarily or without considering the pros and cons of the age and the condition of the patient.

The National Commission held that on the facts found by the State Commission, it is difficult to hold that the patient's death was caused by any negligence or by the fact that the patient was not immediately kept in ICU, after the operation. [S.K. lyengar v. Bombay Hospital and Medical Research Centre & Ors, 2001 (1) CPJ 23 (NCDRC)]

13-57.1 O Post-operative care-Negligence in-Surgery-Gall stones and chronic cholecystitis-Removal of stitches after 6 days of operation and the same day patient having a bout of cough causing abdominal burst and pain, and ultimate death after 14 days-Compensation of Rs. 50,0001- and costs ofRs.1, 0001- awarded by District Forum upheld by State Commission-The Complainant's mother was suffering from abdominal pain and was taken to the Opposite Party Hospital, where Opposite Party No.3 before the District Forum, diagnosed that she was a patient of gall stones and chronic cholecystitis. Operation was performed on 2.5.1995. On 8.5.1995 stitches were removed. On the same day, when the patient had a bout of cough following which there was abdominal burst and the abdominal pain which was repaired on the same day. On 9.5.1995, the patient complained of chest pain. She died on 23.5.1995, in spite of efforts by Dr. Jog, Cardiologist. Complaining deficiency in service the complainant, i.e. the son of the patient, filed a complaint claiming a sum of Rs. 1,75,000 towards expenses, mental pain and sufferings, before the District Forum which awarded Rs. 50,000 for alleged medical negligence for mental agony and Rs. 1,000 as costs of the proceedings. On appeal, the State Commission found that though both the parties had filed their respective affidavits, but no opinion of medical expert was filed from either side. On the point, as to when abdominal disruption can occur, the State Commission referred to the Medical Book Bailey and Love's Short Practice of Surgery, Sixteenth Edition, which reveals that deep sutures should remain in place at least for 14 days and in this particular case, as per the case-sheet, the sutures were removed after the sixth day. In this context the State Commission held as under: "We, therefore, find that though there was no negligence so far as the operation part is concerned, but there had been lapse on the part of the hospital staff in post-operative care. Though the antibiotics were administered to the patient but when she developed complaint of cough and expectoration then there should have been a special care because this wound caused abdominal disruption. Bailey's and Love's Short Practice of Surgery, Sixteenth Edition at page 1056 says that there are more frequent chances of burst in cases of upper abdominal incisions than lower abdominal incisions which we quote: 'It is interesting and instructive to note that upper abdominal incisions disrupt more frequently than lower abdominal incisions and that the suture material employed appears to have no bearing on the incidence of the disaster.' In the present case, incision was on the upper side of the abdomen, therefore, chances of abdominal burst were much more and the hospital staff should have taken all care' '. : In view of the above discussion, the State Commission held that there was negligence ~ on the part of the staff of the hospital and the death was due to negligence of the hospital I authorities and affirmed the order of the District Forum. [Suyash Hospital ( P) Ltd. v. i; Prassanna Kumar Ojha, 2003 (2) CLD 451: 2003 (2) CPJ 150 (NCDRC) ] ~

13-57.11 Post-operative care-Cardiat surgery-Surgeon-Departure for ( abroad before discharge of patient-Hospital having other well qualified and ; experienced doctors and staff to look after the patient-Leaving of surgeon for abroad, no negligence attributable to death of patient-In the instant case, a case of cardiac surgery, respondent-2 attended on the patient on 16th October and left for the overseas trip on 19th. It is no one's c~use that the patient was not being properly attended to. There were experienced and well qualified Doctors/Staff in the Hospital to look after and attend to the deceased. There is no negligence in this regard. [Kiran Bala Rout v. Christian Medical College & Hospital & Ors., 2003 (1) CPR 238 (NCDRC)]

13-57.12 Post-operative care-Improper-Cardiac surgery-Profuse bleed- ing-Inability to stop-Ultimate death of patient-Held negligence per se-Com- pensation of Rs. 3 lac awarded in ratio of 2: 1 to be paid by hospital and surgeon respectively-Refund of Rs. 1,45,000 paid to hospital and costs of Rs. 2,000/- also ordered-The grievance of the complainants against Dr. Bawa Dass is that after performing CABG on the patient he did not issue any instructions to the doctors of OP-1 BRS Heart Institute and Research Centre and did not prescribe follow up treatment and supervise the patient who had a continuous bleeding which resulted into further re-explorations at OP-1 BRS Heart Institute and Research Centre, still the life of the patient could not be saved and he eventually died on 13.10.1999 at OP-1 BRS Heart Institute and Research Centre.

The two surgeons who assisted in the cardiac surgery were unable to properly treat and look after in the post-operative care and they could not stop the bleeding which led to the ultimate cardiac arrest of the patient, who was declared dead at 1.40 a.m. on 13.10.1999. Complaint allowed to the extent that the O Ps 1 & 3, i.e., BRS Heart Institute and Research Centre and Dr. B. Dass respectively to pay a sum of Rs. three lac as compensation for the death of S. Balbir Singh Uppal on account of their medical negligence and deficiency in service in the ratio as mentioned hereinafter i.e. their inter se liability would be of the ratio of 2/3rd and 1/3rd. In other words, a sum of Rs. two lac shall be paid by the BRS Heart Institute and Research Centre while a sum of Rs. one lac shall be paid by Dr. B. Dass. Apart from this, OP-1 is directed to refund a sum of Rs. 1,45,000 deposited towards various heads. The OP-1 hospital further directed to pay a sum of Rs. 2,000 to the complainants as litigation expenses. [Kuljit Kaur v. B.R.S. Heart Institute and Research Centre, 2003 (6) CLD 317 (Chd. UTCDRC)]

13-57.13 Post-operative care-Administration of wrong injection-Surgery for acute appendicitis-Duty nurse giving injection "fancuran bromide" 2 ml. mistaking it for an analgesic resulting in total muscular paralysis, cyanosis and bradycardia-Went into 'hypoxia' and ultimate death due to cardiac respiratory arrest within 10-15 minutes-Negligence in post-operative care-Hospital, doctor and the nurse held jointly and severally liable-Rs. 2 lac awarded as compensation and Rs.10,000 towards costs-[P. Sudhakar v. Gowri Gopal Hospital, 2004 (1) CPJ 329 (AP-SCDRC)]

Foreign Case

13-57.14 Post-operative care-Appendectomy-Giving instructions to parents I of child patient-No negligence-A child left the hospital the morning after an

operation for appendicitis. That afternoon his mother called the surgeon and described his symptoms and the surgeon told the mother that it was not necessary for him to come to see the child. He told her to come and pick up some medication at his office, which she did. The following day, the boy's father called the surgeon and described more symptoms and was told to come and get more medication, which he did. The court held that the defendant did not act improperly in failing to see the patient personally since he had enough information on. which to make an accurate estimation of the child's condition. [Riggs Christier, 173 NE 2d 610, Mass 1961.]

13-58 PRIORITY OF SEEING PATIENTS 13-58.1 Priority of seeing patients-Patient to be examined first-Doctor's absolute right to decide-A doctor has the absolute right to decide which patient he would examine first and even out of turn depending upon the condition of the patient. He also has the right to examine patients in their turn and it cannot be maintained that a patient must be examined by the doctor at the appointed time irrespective of the time he may have to spend in examining the previous patient. [Dr. Sudhanshu Bhattacharya v. B.S. Hegde, 1993 (3) CPR 414 (Mah. SCDRC).]

13-59 PROFESSIONAL MISCONDUCT 13-59.1 Professional misconduct-Doctor in government service-Advice to admit patient in his private nursing home, amounts to misconduct-Where the complainant took his ailing son to the Govt. Health Centre, the oppo$ite party Medical Officer advised him to admit the patient in his private nursing home, the Commission held that it amounted to misconduct, and observed that it was for the State Govt. to take administrative action against the doctor. [Dr. Ranjit Singh But tar v. Sewa Singh, 2000 (2) CPJ 180 (Punj. SCDRC)]