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NCDRC: 50 lakh compensation for failed tooth extraction leading to 14 surgeries and extraction

“Not even a bonafide mistake, but a therapeutic misadventure”

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) upheld an order issued by the Rajasthan State Consumer Disputes Redressal Commission and directed Jaipur-based Narayana Hridayalaya Ltd (Narayana Multispecialty Hospital) along with cardiac consultant and another doctor to pay Rs50 lakh compensation with 9% interest to the complainant patient. In a somewhat shocking case complainant patient who had sought medical attention for tooth extraction ended up undergoing a total of 14 successive surgeries, administering of 42 units of blood, rupture to his heart, blood into his lungs, gangrene in the leg where the catheter was inserted, amputation of his leg up to the knee and further amputation up to the hip. 

The ordeal of the patient started when he went to Soni Hospital for a tooth extraction. However, during the procedure, he experienced excruciating pain, leading to his admission to the hospital. Angiography was conducted on the patient and it revealed 60%, 70%, and 100% blockages in his arteries. After seeking a second opinion he consulted Narayana Hridayalaya Ltd where he was advised stent placement by the consulting cardiologist. Following the procedure for stent placement at Narayana Hridayalaya the patient experienced chest pain leading to multiple surgeries and the eventual amputation up to the hip due to gangrene.

The bench noted “In the present case, however, it is undisputed that the Complainant who had sought medical attention for tooth extraction, ended up in undergoing a total of 14 successive surgeries, administering of 42 units of blood, rupture to his heart, blood into his lungs, gangrene in the leg where the catheter was inserted, amputation and his leg up to the knee and further amputation up to the hip. As regards the contention pertaining to the stand of the State Commission in respect of option of open-heart surgery, the same was an observation, based on the version of the doctors themselves that, in the given condition of the blockages of the Complainant, open heart surgery was more appropriate and that it was the Complainant who had sought angioplasty as against open-heart surgery. As regards consent, after he was taken in for angioplasty, all along, he was in very critical state with imminent threat to his life. Thus, the consent that was obtained was without scope for any informed deliberations and making decision. It was rather without option to him or his relatives. As regards allegation of medical negligence, evidently the critical pre-operative checks to determine his suitability to undergo the surgery were not carried out. This failure was discovered after completion of angiography when continuous bleeding was noticed from the leg where catheter was inserted. Only then it was discovered that he was suffering from PVD, and further complications emerged as a sequel. In addition to the insertion of catheter from the leg to patient suffering PVD, the negligence is also conspicuous as this procedure further resulted in rupturing his heart, profuse bleeding, accumulation of blood in lungs, loss of sensation to his leg and infection. Ultimately, this led to gangrene, 14 surgeries and amputation of his right leg first to the knee and thereafter up to the hip.”

The bench concluded “No explanation has been rendered as to why the foot of the Complainant from where the catheter was inserted for angioplasty as well as his heart continued to bleed, leading into emergency situations. When his heart ruptured and was bleeding continuously to alarming proportions, medicines were given to thicken the blood. He had PVD problem in his leg and despite that angioplasty was done. He was not put through the procedures of preoperative care to check his fitness for surgery. After the operation, the heart ruptured, and bleeding started and blood went into lungs and the gangrene in his leg kept increasing. Even then the Complainant was not referred for specialist treatment. When his blood was diluted, it was oozing out of the heart and when the blood was thickened, gangrene was spreading. Due to gangrene, foot started to blacken from below and then the leg had to be amputated up to knee, and later up to hipbone. The doctors did not even try to stop it and continued to experiment and conducted 14 operations and administered 42 bottles of blood and pushed him to the verge of death. The deficiency in service and medical negligence of the doctors are clear. The doctors repeatedly asserted in their arguments that when his heart was ruptured and bleeding, most important was to save his life. However, when gangrene was developing and two contradictory results were possible and both are likely to result in unacceptable damage to the patient, it was their duty to refer him to some advanced center in time for further specialist treatment, rather than continuing to experiment on him. Evidently, this was possible within and around Jaipur but the doctors failed to do so.”

The NCDRC bench of Subhash Chandra (presiding member) and air vice-marshal (AVM) J Rajendra (retd) (member) says, “Even when the patient was in critical distress, Narayana Multispecialty Hospital, the doctors continued with experimental procedures, instead of promptly ensuring more seeking specialised medical attention. It jeopardised his safety. Therefore, medical negligence is conspicuous even to the naked eye…Considering the facts and circumstances of the case, the compensation awarded by the state commission to the complainant is just and fair.” NCDRC also observed that in this case, the doctors were found negligent on all the counts as discussed in the Supreme Court judgement in the case of Dr Laxman Balakrishna Joshi vs Dr Trimbak Bapu Godbole. “It was not even a bona fide mistake, but a therapeutic misadventure,” the bench says.

Legal PrescriptionThe doctors should always take exhaustive history of the patient before any  procedure especially the critical proceduresThe patient should always be subjected to pre-operative checks to determine his suitability to undergo the surgeryThe patient should be referred to advanced facility as soon as it becomes evident that the patient requires specialised medical attention which is not available in the facilityThe doctors should not experiment as  soon as they realise that the treatment of the patient is beyond their expertise