The National Consumer Disputes Redressal Commission (NCDRC) directed Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute in Juhu (Mumbai) and a doctor from the hospital to pay Rs40 lakh compensation in equal proportion to a patient for alleged medical negligence and deficiency in service. The order, if not implemented within six weeks, will carry an interest of 9% per annum till its realisation. The patient had suffered paraplegia after surgery at the Hospital and informed consent about it was not undertaken.
In an order issued this week, presiding member Dr SM Kantikar says, "Dr Mihir Bapat is held liable for the act of 'commission' and 'omission' during the treatment of the patient. Also, the hospital is vicariously liable for the deficiency in services. It was the duty of the hospital to ensure the standard of patient care. The doctors or the concerned staff were accountable, who failed to adhere to the Standard operating procedures (SOP)."
"Adverting to the compensation, I would like to rely upon the law laid down by the Supreme Court. The patient post-operatively suffered irreversible damage- i.e. paraplegia for his remaining life. The complainant deserves just and reasonable compensation because such a patient needs an electric bed, air mattress to avoid bed sores, deep vein thrombosis (DVT) pump to avoid deep vein thrombosis, automated wheelchairs and walker," NCDRC noted.
The case is related to a complaint filed by Rohandeep Singh Jaswal, through his constituted attorney and father, Sanjeev Jaswal, against the Hospital and its 12 doctors, including Dr Bapat.
Mr Jaswal had consulted Sir Ganga Ram Hospital in Delhi for his son's kyphoscoliosis spinal deformity when he was 12 years old. It was diagnosed as an intramedullary tumour and operated in October 2004. The tumour was reported as non-cancerous ganglioglioma, but the doctors advised to take care and accordingly, magnetic resonance imaging (MRI) was done yearly.
In 2012, the MRI revealed a tumour of shrunken size. Since the Jaswals had moved to Ahmedabad, he sought consultation at Shalby Hospital there. The doctors suggested 65% correction through surgery with a neuro-monitoring machine and related facilities to avoid neurological complications.
In February 2014, the patient consulted Dr Bapat at Kokilaben Hospital in Mumbai. It was alleged that the patient was told that as the spine is flexible, 80%-90% correction is possible. The operation was scheduled on 16 April 2014, but was postponed to 23 April 2014, as the neuro-monitoring machine was under maintenance.
Mr Jaswal, in his complaint, alleged that no informed consent was taken. "The surgery took a long time, from 7am to 4pm. After the surgery, the patient was shifted to a room. Dr Bapat came to the room and informed that the patient regained consciousness but not moving his legs; therefore, re-surgery was necessary for releasing the implants and to reduce the correction as carried out in the spine."
However, after surgery, the patient's parents were shocked to hear that there was no leg movement and there was no sensation below the chest (rib cage) of their son. The patient also suffered from meningitis.
It was further alleged that the patient heard the doctors' conversation that they should not have accepted and operated on the case. Dr Bapat did not inform the condition as it was 'paraplegia'. After that, the condition of the patient continued to deteriorate.
On 27 July 2014, Rohandeep was discharged from Kokilaben Hospital in paraplegic condition (loss of senses below the rib cage), with no bowel and urine control. For the daily routine activities of the patient, an attendant was needed. Till 7 February 2015, he remained admitted to Dhirubhai Ambani Occupational Health.
The family consulted a number of doctors, but Rohandeep's condition did not improve. As advised by Dr Bhoj Raj on 4 October 2014, a contrast computerised tomography (CT) myelography test was performed. It revealed D-8 vertebra was slightly wedged before surgery and got totally crushed during the surgery, indicating severe stretching or blockage at the point of the vertebra.
The Jaswals then filed a complaint before NCDRC seeking compensation of Rs58.92 crore from the Hospital and the doctors.
The Commission, in its order, observed that the consent forms for anaesthesia and surgery were devoid of details about the risks of paraplegia. It also said that the doctor did not seek the opinion of a neurosurgeon.
"A specific query was put to the authorised representative (AR) (of Dr Bapat) about the informed consent in the instant case. He submitted that the patient had the knowledge of spinal surgery and moreover during every visit and discussion with Dr Bapat, it was explained to the patient and his parents about the operation and its complications. According to AR it was deemed to be consent. The documents on record are unsigned prescriptions which in my view it does not construed as 'informed consent'. Thus it is evident that Dr Bapat failed to obtain informed consent for surgery in the instant case," Dr Kantikar from NCDRC says.
Describing informed consent as one with four components – decision capacity, documentation of consent, disclosure, and competency – the NCDRC stated that the two well-recognised exceptions are medical emergencies and another is a 'rare' case.
Calling neurosurgery and orthopaedic surgery as two high-risk specialities associated with some of the highest numbers of medical negligence litigations, the Commission said that spinal surgery, most commonly at the lumbar level, has the highest rates of litigations.