Complications in Kidney Transplantation resulting into death of patient, but Rs.2.35 Crore case against Doctors, dismissed.

Doctors and Hospital were discharged from the allegations of Medical Negligence  for Rs.2.35 Crore compensation was claimed  in   a  Unique case in respect of Organ Transplantation, where the main allegations may be summarised as under :

"a) Why removal of both kidneys (laparoscopic bilateral nephrectomy operation ) was a precondition to a  kidney transplant ?

b) Why doctors failed to perform a renal transplant despite availability of kidney donor ?

c) Why more than six operations were performed on the patient during the stay in the Hospital, which ultimately resulted into death of the patient and the consent was given under duress ?

The case goes back to year 1999. 

The National Commission in its judgment delivered in the case of Smt. Jyoti Chopra V/s. Indraprashta Medical Corporation Limited & ors observed at the threshold as ,

“Careful preoperative work-up of every transplant candidate is mandatory to improve post-transplant organ and patient survival. The workup should be tailored according to patient's` specific conditions, by a multidisciplinary approach before proceeding to transplantation”.

 ( see the link : 

https://indiankanoon.org/doc/48103794/

The judgment is 16 pages and rival contentions were advanced by both the parties and expert opinion given by AIIMS was in favour of Doctors.

AIIMS opined that "the renal transplantation is never an emergency life-saving surgery, since patients of End-stage Renal Disease can be sustained indefinitely on hemo-dialysis; and the mere presence of a kidney donor does not mean that renal transplantation should necessarily be performed in a hurry. This patient had an infected urinary tract with residual renal stone and bilateral hydronephrosis. Hence, it was completely justified to perform pre-transplant bilateral nephrectomy. In fact not investigating for causes of recurrent stone disease, and not performing bilateral nephrectomy would be considered deviation from standard clinical practice. Dialysis patients are always at high risk of intra and peri-operative surgical complication. It is our considered opinion that multiple  interventions were necessary and per se there is no evidence of medical negligence.”

The National Commission relied upon the opinion of the AIIMS as well as upon other literature and after perusing the entire medical record and various case laws, observed that availability of a suitable donor alone was not enough to proceed with the major operation of a kidney transplant, the patient also must be fit for Kidney transplant and kidney transplantation is not a miracle therapy for kidney failure. Following nephrectomy , hemodialysis was duly carried out on the patient.  The Commission further observed that after discharge, the patient had developed fever and the patient was transferred to the free patient’s ICU and hence, there was no financial implication to the family.

While denying the allegations of negligence against the Doctor for choosing wrong treatment and deviating from normal line of treatment , the Commission relied upon the landmark judgement of Hon'ble Apex Court os Samira Kohli V/s, Dr. Prabha Manchanda & Anr. Appeal (Civil) 1949 of 2004 dated 16.01.2008, wherein it was observed that 

“IT is for the doctor to decide, with reference to the condition of the patient, nature of the illness and the prevailing established practices as to how much information regarding the risk and consequences should be given and how they should be couched in the best interest of the patient. A doctor acting accordingly with normal care and in accordance with a recognized medical practice cannot be said to be negligent merely because body of opinion taken a contrary view. In modern medicine and surgery dissection of the various thing a doctor has to do in the exercise of his whole duty of care owned to his patient is neither legally meaningful nor medically practicable."

In spite of every effort, the patient’s fever and infection continued, hence transplantation was not possible, therefore unfortunately the patient died, but the commission rejecting the allegations of Negligence on this count relied on the judgement of Supreme Court in the case of Martin F. D’ souza vs. Mohd. Ishfaq ”, 2009 CTJ 352 (Supreme Court) (CP) in which the Hon’ble Supreme Court was pleased to observe as under:-

“ A medical practitioner is not liable to be held negligent simply because things went wrong from mischance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference to another.”

“  when a patient dies of suffers some mishap; there is a tendency to blame the doctor for this. Things have gone wrong and, therefore, somebody must be punished for it. However, it is well known that even the best professionals what to say of the average professional, sometimes have failures. A lawyer cannot win every case in his professional career but surely he cannot be penalized for losing a

case provided he appeared in it and made his submissions.”

This judgment again underlines the important factor that proper medication, proper medical record saves Drs. from clutches of medical negligence cases.. Moreover the case is of 1999 and now after 20 years, there must have been more better treatment and techniques. 

The death of near-dear one is beyond any monetary compensation. The person gets mentally and physically tired during Hospitalisation. 

IF there is proper dialogue by and between the Patients and Doctors, many Court cases could be avoided.  

ALWAYS REMEMBER, one cannot stop anybody from filling the case, but its end result may be different. Like I have stated in my earlier Articles also that as there is no Court Fees imposed on the Complainant in ratio of the Compensation claimed, one can file any amount of Compensation case. But in Civil Court, Court Fees is to be paid slab-wise in the ration of Suit Claim.

Thanks and Regards

Adv. Rohit Erande

Pune.©