The National Consumer Disputes Redressal Commission (NCDRC) has granted relief to a Kerala-based hospital and its doctor who performed laparoscopic appendectomy surgery on a patient suffering from acute appendicitis after noting that the doctor made the correct diagnosis and treated the patient as per the standard practice.
The revision petition was filed by Eldho David, father of the patient (Sheba David) against Dr Denny Kuttikat and Carmel Hospital at Ernakulam in Kerala challenging the order of the State Commission.
The case relates to 2010, when on 22 February 2010 the complainant's daughter was taken to the casualty at the treating hospital for severe abdominal pain. It was diagnosed as acute appendicitis and the casualty doctor advised immediate surgery. On 23 February 2010, the doctor performed laparoscopic appendectomy and after two days the patient was discharged.
However, as the patient did not get relief from the pain, she continued to take medicines. She was again taken to the same hospital after a few days and on 29 February 2010, the treating doctor referred the patient to a second hospital for CT scan and further treatment. The doctors at the second hospital operated on her and removed the pus from the abdomen and she was discharged on 12 March 2010.
The petitioner approached the district forum of the consumer court and filed a complaint seeking compensation of Rs2.45 lakh from the doctor and the hospital. In the complaint, the petitioner claimed that due to the deficiency in the service of the treating doctor at the first hospital the patient had lost an academic year.
Both the doctor and the hospital denied the allegations cited in the complaint and argued that the appendix showed features of mild inflammation and there was no evidence of local or generalised peritonitis and no free liquid or pus in the peritoneal cavity. They submitted that as on 24 February2010, the girl complained of mild pain in the umbilical port site and it was treated symptomatically. The girl was discharged with follow-up advice. They asserted that the girl was treated with utmost care and there had been no negligence from their side.
The district forum partly allowed the complaint and held that the doctor and hospital were partly liable for negligence and deficiency in service. In its order, the district forum directed the authorities to issue a refund of the expenses of the treatment and observed “We are of the view that the complainant succeeded in prima-facie proving the deficiency in service of the part of the Opposite Parties in conducting the physical examination of the patient during pre-operative segment. The failure on the part of the Opposite Parties in taking abdominal X-ray of the patient to detect fecalith, ultra sound scan or computed tomography scan to confirm the disease though not mandatory amounts to the further deficiency on the part of the Opposite Parties since the modern medical world is so advanced to diagnose any such disease…”
“It is to be noted that the patient a tender aged girl had to suffer lot of inconveniences mental pain and suffering and physical agony due to the negligent acts of the Opposite Parties which could have well been avoided if proper care and caution been taken in which they failed. The complainant has to spend the amount at PVS Hospital. The Complainant has not produced the records to show the treatment expenses incurred by him at the 2nd Opposite Party hospital probably due to his mental agony are worse. However, the complainant is entitled to get refund of the treatment expenses at the second opposite party, the hospital and to get reimbursement of the amounts,” the forum said in its order.
The hospital and the doctor appealed against the order in the State commission which set aside order passed by the district forum. It noted, "From clinical examination itself the appendicitis can be diagnosed by a prudent doctor and the performance of the appendectomy is the proper diagnosis and the standard treatment had given to the daughter of the complainant." It further added that "the pre-operation diagnosis was acute appendectomy and it is also evident from the histopathology report showing 'impression-appendectomy showing acute appendicitis. So, there can be no other possibility for any default in the diagnosis of the 1st opposite party."
The petitioner challenged the order of the State commission in the NCDRC and quoted his debt and other expenses due to the expensive treatment for his daughter and the following legal proceedings as reasons for delay in filing the revision petition.
The NCDRC thoroughly investigated the operative and clinical findings. Based on the discharge summary of the second hospital (PVS Hospital), the apex consumer court found that the patient was diagnosed with an "intra-abdominal abscess". "She had a surgical site infection in the sub umbilical region of lap site which required daily dressing and probably secondary suturing," mentioned her medical report.
The apex commission went through the standard surgical textbooks and articles on laparoscopic appendicitis. After going through all the medical literature material, the commission concluded that laparoscopic appendectomy presents a lower incidence of surgical wound infection, lower incidence of postoperative ileus, lower use of analgesics in the postoperative period, an earlier resumption of normal diet, a shorter hospitalization, and a more rapid recovery to resume normal activities compared with patients undergoing open surgery.
The commission also observed that an intra-abdominal abscess occurs rarely after laparoscopic appendectomy and is strongly associated with complicated appendicitis. Its treatment is associated with the need for intervention. The commission confirmed that while the histopathology report was confirmatory of acute appendicitis; the operative findings of the second hospital also did not show any injury to the small bowel, stomach or any internal organs.
Hence, the NCDRC noted "The purulent turbid fluid in the abdominal cavity was due to peritonitis-infection without any injury to the bowels or internal organs. The infection or abscess in the peritoneal cavity was not due to any negligence or any shortcoming during the laparoscopic procedure."
The NCDRC disposed of the revision petition while adding that the State Commission was well-apprised and well-reasoned and observed that the treating doctor had correctly diagnosed the case and treated the patient as per the standard accepted practice.