Human body being a highly complex machine, a physician would not assure the patient of full recovery in every case. : Adv. Rohit Erande

Human body being a highly complex machine, a physician would not assure the patient of full recovery in every case. : 

Adv. Rohit Erande. ©

Case Details :

APARNA PANDEY & ANR V/s. INDRAPRASTHA APOLLO HOSPITALS DELHI & ORS

decided on 01/06/2021

Decided by : HON'BLE DR. S.M. KANTIKAR,PRESIDING MEMBER, 

Judgment Link : 

http://cms.nic.in/ncdrcusersWeb/GetJudgement.do?method=GetJudgement&caseidin=0%2F0%2FCC%2F161%2F2008&dtofhearing=2021-06-01

Facts in Short :

1. On 03.12.2006, Mr. Umesh Pandey, 36,  (since deceased, hereinafter referred to as the “patient”) visited the Indraprastha Apollo Hospital, Delhifor the complaint of jaundice. The opponent no.2 in this case, Dr. Subhash Gupta  examined him and after conducting investigations admitted the patient in the  Hospital and was advised for urgent Liver Transplantation and it is the case of the Complainant that the Doctor further assured of 100% success since its the safe & routine surgery in these days and the patient can resume normal duty after 2 months. 

2. As the Complainant -wife of the deceased and two other donors' liver not found to be suitable, patient's mother-in-law's liver found to be suitable. the total package of 15 lakhs was given and the Hospital also obtained various permissions.

3. It has been alleged that during the liver transplant surgery, the Doctor committed negligence and there was huge blood loss metabolic acidosis and the patient was kept in ICU after the surgery. As the patient became critical, therefore, on 19.12.2006 the other team of doctors hurriedly performed second surgery after realising that there was continuous bleeding from the active bleeders which were not closed properly during first operation.

4. It has been further alleged that Opponents  failed to exercise reasonable care during operation, and as per standard procedure failed to monitor hourly condition of patient. The Doctor unnecessarily delayed the 2nd operation by two days which caused further deterioration of the patient. It was alleged that the the source of bleeding and bleeders were not traced and further  renal haemodialysis was performed  without any justification It was gross negligence and deficiency in the service. and that the attitude of doctors towards the patient was not good. Ultimately the patient's condition deteriorated with fungalsepsis and he  succumbed to death 29.12.2006. Thus the complainant along with her 2 minor children filed the compliant for claiming compensation to the tune of Rs. 2,06,13,496/- alongwith 18% interest .

Defence :

1. The Opposite Parties submitted that in the year 2002, the patient was diagnosed as Chronic Liver Disease (CLD). The patient’s wife suppressed certain material facts in the pleadings that the patient was treated at Metro Hospital for liver cirrhosis and acute on chronic liver failure. The patient was admitted on 03.12.2006 in the hospital emergency ward with the complaints of yellowish discolouration of eyes, nausea, vomiting and mild pain in abdomen since two months

2. There was mild ascites, splenomegaly and left renal hydroneprosis. The earlier endoscopy revealed esophagial varices and MRI revealed scerotic changes with liver parenchymal disease. The patient’s critical condition was explained to the patient’s relatives and informed about the tentative expenses of liver transplant.

3. A high risk consent was also obtained. Post-operatively, the patient developed renal failure, gross coagulopathy and severe portal hyper-tension. Commonly, the post-operative bleeding seen due to coagulopathy and it takes 24 to 40 hours for the transplanted liver to start functioning. During the Transplant surgery continuous blood investigations for coagulopathy were performed. The doctors denied the allegation that active bleeders were not closed properly during first operation. Few patients often need re-operation depending upon the patient’s clinical assessment.

4.     The Doctor denied that   simply the blood clots from abdomen of the patient were removed during 2^nd operation without finding the source. The  2^nd surgery performed on 19.12.2006 was Exploratory Laparotomy for evacuation of the blood clots and abdominal lavage. The clots were mainly present in the peri-hepatic region and the site of bleeding was not pinpointed during the surgery. The Complainant failed to prove that the bleeding continued even after the 2^nd operation.

5. As per protocol, the anti-rejection treatment is to be given to the patients after liver transplant, however it reduces the immunity and the patient becomes prone for infections. In the instant case, the patient developed fungal infection and was treated with due care as per the clinical signs. The patient expired because of natural consequences of the chronicity of the disease, it was neither due to any negligence nor deficiency from the treating doctors.

Held ;

1. The Medical Board  of AIIMS, New Delhi. also observed in its Expert report dated 29.07.2015 that there was no Negligence on Part of Hospital and Doctor. 

 The hon. Commission opined that, it is apparent from the medical record that the patient was treated by a multi-disciplinary team of doctors during his hospitalisation. The entire procedure, treatment, surgeries and dialysis were performed after explaining the prognosis’ to his family. 

2. The Post-operative monitoring and wound dressings were done regularly. The patient, after liver transplant, suffered renal failure and very high Bilirubin level. Fungal infections are known to be opportunistic infections in such patients. The anti-rejection treatment affects the immunity of the patient and became prone to fungal infections. There was no deficiency in the treatment as alleged. The patient developed necrosis / gangrene and septicaemia which could not be attributed to negligence in the instant case.

3. It relied upon the Medical Literature and held that the success of transplant procedure may be limited by infectious complications. Most fungal infections occurred within one month of liver transplant surgery. Bacteria, and less commonly Candida infections, remain the predominant pathogens during the immediate post-operative period, especially during the first month. 

4. It is estimated that up to 80% of liver recipients will develop at least one infection during the first year after transplantation, and, while most are successfully treated, some will result in death. The precise diagnosis of rejection in liver transplant recipients is often difficult, and tissue evidence is not always available.  It is also known that steroid treatment in a 3-month period prior to transplantation lead to subsequent development of fungal infections.

5. it further relied on the judgment of Hon. Apex Court in the case of Dr. S.K. Jhunjhunwala vs Mrs. Dhanwanti Kumar, Civil Appeal No. 3971 of 2011, decided on 01.10.2018, wherein it has been held that, " doctor or surgeon cannot assure  and does not guarantee that the result of surgery would invariably be beneficial, much less to the extent of 100 % for the person operated on". The Hon’ble Supreme Court while allowing the appeal held that a professional may be held liable for negligence on one of two findings: either they did not possess the requisite skills that they claimed to have, or they did not exercise, with reasonable competence in the given case, the skill which they did possess. lastly it relied upon the celebrated case of Jacob Mathew vs. State of Punjab (2005) 6 SCC 1, wherein 3 judges bench has observed that the human body and its working is nothing less than a highly complex machine and a physician would not assure the patient of full recovery in every case. 

It is an important case indeed. As this case is of 2008 it was filed on national Commission directly and thanks to Court Delay, the case was decided in 2021 !!. It was indeed very unfortunate thing for the wife to lose her husband at such an early age of life leaving two minor kids with her  to be looked after.  The organ Transplantation surgeries are performed regularly in these days and such surgeries are costly and involves great risk too. Though the Doctors give their all out and would never want their surgeries to fail. This judgment implies yet again universal truth that "Medical Science is an incomplete science".

Thanks and Regards, 🙏

Adv. ROHiT Erande, ©

Pune.