Case Study

Cotton Gauze Left Inside After Surgery-“res ipsa loquitor”

Ku. Samiksha v. Acharya Vinoba Bhave Rural Hospital, Revision Petition No. 1361 of 2015  decided by National Consumer Disputes Redressal Commission, New Delhi On 20.09.2019

Facts: 02-03-2004- The Patient aged 3 years was taken to the Hospital for Complaint of fever and was admitted as inpatient from 02.03.2004 to 05.03.2004 diagnosed to be suffering from Brancho Pneumonia.

11.03.2004- As the fever continued she was once again admitted on 11.03.2004 and the doctors diagnosed the Patient to be suffering from Vasico Uretery Reflex problem (VUR) coupled with cystitis. Hydronephrosis and hydroureter problems.
03.04.2004- Bilateral VUR operation was conducted, the reimplantation of uretery  was not successful and there was continuous oozing of urine from the bladder and the stitches.

17.04.2004- One more operation was conducted on the Patient opening the abdominal cavity and it was diagnosed that VUR was persisting with the right side and second reimplantation of right side ureter was done.

April, 2004- Flow of urine from the stitches and the bladder continued.

30.04.2004-  The Complainant was discharged and she was called for post-operative care on 03.05.2004, 07.05.2004 and 10.05.2004, during which time  the oozing continued.

May,2004- It Was at Vasant Nursing Home, Nagpur that A Senior Urologist Dr. Suhas V. Salpekar, operated  upon the Patient and diagnosed that a cotton gauze  i.e. a foreign body was found inside the bladder.

29.08.2005- The Complainant filed a Complaint before the District Forum.

08.09.2006-Kidney of the Patient was removed at KEM Hospital.

21.02.2007- The Complaint was amended seeking compensation of `20,00,000/- (seeking additional compensation of `10,00,000/- on account of the subsequent events of kidney removal and the future expenses).

Observations: Before the District Forum Dr. S.V. Salpekar had answered the questionnaire, which evidences that on 14.05.2004, he had seen the Patient and stated that when the Patient had initially seen him, she had watery discharge from the supra pubic wound and that he had performed Cystoscopy and removed the foreign body. During Cystoscopy he had found a foreign body in the lumen of the bladder which was removed with the forceps. He further submitted that he had last seen the Patient on 02.07.2004, but could not recollect that the Patient had developed incisional hernia. Deposition of Dr. Abhay Gupta, Department of Pediatric Surgery KEM Hospital, which reads as under:

Q. What is the treatment of choice for V.U.R. problem?
Ans. The treatment for VUR in each child is individualized and taken into account the child’s gender, reflux grade, age, presentation (UTI, screening, antenatal diagnosis), renal status at beginning of therapy, compliance with treatment, likelihood of reflux resolution as well as parent and child preferences.    Indication for surgery include break through urinary tract infections despite prophylactic antibiotics  because of non compliance, persistent high grade reflux, congenital anomalies of the VUJ, new renal scars and persistent dilating reflux in girls.

Q. what was the condition of Ku. Samiksha previous to her admission of your Hospital?
Ans. As per the details obtained from her previous discharge cards, Pt. was subjected to bilateral reimplantation of ureters on 03.04.04 and on 17.04.04 reexploration with ® ureteric reimplantation and subsequently  in May 2004 Cystoscopy with removal of foreign body done at Vasant Nursing Home. As per history of patient, Pt. had multiple episodes of urinary tract infections after that and was admitted to K.E.M. Hospital on 08.08.2006.

Q. Whether re-implantation is the only solution of V.U.R.   Problem and what is the re-implantation surgery and how it cures the V.U.R. problem?
Ans. Reimplantation is one of the surgical options for V.U.R. In reimplantation surgery, the ureter is reimplanted at another site in the bladder by creating longer muscular tunnel and thereby controlling V.U.R.

Q. After re-implantation surgery what are the causes behind oozing urine/ watery discharge from the stitches, whether it occurs after such type of surgery?
Ans. The causes could be due infection of due to stitch disruption in bladder.

Q. Could there be any medical purpose for leaving Foreign Body (F.B.) in bladder?
Ans. No.

Findings: The deposition of Dr. Suhas V. Salpekar read with the deposition of the doctors of KEM Hospital and the Hospital treatment record, we are of the considered view that a cotton gauze was indeed left behind during the re-implantation surgery performed in the Hospital, which was later removed in May, 2004 by performing a Cystoscopy. Patient was treated for urinary tract infection at KEM Hospital, Mumbai and the treatment record evidences that the left kidney was affected on account of dilation, accumulation of fluid in the pelvic calyx system. Leaving of the cotton gauze is per se negligence and we do not find any illegality or infirmity in the concurrent finding of both the fora below with respect to negligence on behalf of the Hospital in the treatment of the Patient. The Deposition of the Doctors shows that even in the  future, the child may be  subject to various complications including hernia  which  may arise out of the procedures which the child was subject to. Apart from this, the fact remains that the child has only one kidney and her definitely restricted her life style with respect to physical movements in many aspects. Revision Petitions No. 251 of 2015 and 905 of 2015 preferred by the Hospital and the Insurance Company are dismissed and Revision Petition No. 1361 of 2015 filed by the Complainant is allowed in part modifying the order of the State Commission to the extent THAT Compensation be enhanced from `6,00,000/- to `18,00,000/- while setting aside the interest @ 9% p.a. awarded by the Fora below. This amount of `18,00,000/- is exclusive of medical expenses of `1,50,000/-. awarded by the Fora below.  Time for compliance four weeks, failing which, the amount shall attract interest @ 9% p.a. from the date of filing of the Complaint till the date of realization.

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