Case Study

Deep Vein Thrombosis (DVT)

Dr. Sanjay Garg versus Harjit Singh decided by the
NCDRC on 05.10.2020

FACTS: Complainant’s wife, Smt. Sukhpal Kaur,  on 07.09.2005 underwent hysterectomy by Dr. Sanjay Garg, ( in Delhi Nursing Home, Bathinda, after surgery she was made ambulatory (to walk within 12 hours of surgery) and oral feeds within 24 hours, the urinary catheter was put for 48 hours of surgery and was discharged on 10.09.2005 in satisfactory condition. However, on the next day due to swelling and numbness in her left leg, she was taken to Opposite Party No. 1 in emergency,  her condition further deteriorated and she was taken to M/s Delhi Heart Institute and Research Centre, Bathinda, wherein she was diagnosed as post-hysterectomy DVT with anemia and septicemia. After short treatment, she was referred to Dayanand Medical College and Hospital, Ludhiana, there she was diagnosed as post hysterectomy DVT with septicemic shock with DIC and MOF, the doctors therein informed that the condition of patient was due to the negligence of the Opposite Party No. 1 and the patient died in DMC on 12.09.2005. The Complainant alleged that the operation was performed negligently by the Opposite Party No. 1 and no post-operative tests were conducted to rule out complications such as Deep Vein Thrombosis (DVT) and septicemia.

DEFENCE: Surgery was successfully conducted with due care as per the standard method and the recovery was good. All required precautions were taken during operation and post-operatively. There is no nexus between DVT and the hysterectomy. The Opposite Party No. 1 admitted that the patient was brought again on 11.09.2005 and DVT was diagnosed. After initial treatment for DVT, the patient was referred to the Opposite Party No. 2 wherein she was treated for short period and referred to DMC, Ludhianafor further management. Subsequently, the patient died due to sudden cardiac arrest on 12.09.2005.

Observations: Complaint stated that “on 11.09.2005, in the early morning, patient’s left leg got swollen and became numb. He immediately took her to the Opposite Party No. 1 at Delhi Nursing Home and got her admitted at 7.00 am. The Opposite Party No. 1 Dr. Sanjay Garg attended her, conducted some tests and examinations, and administered some medicines, but failed to control her affliction and consequently her condition got worsened. Thereafter, the Opposite Party No. 1 referred the patient to Delhi Heart Institute (Opposite Party No. 2) for further treatment. In our view, the Opposite Party No. 1 promptly attended to the  complications and made proper referral  to the higher center. In the instant case we do not find any deriliction in duty of care by the treating doctor. In Delhi Heart Institute (the Opposite Party No. 2 Pulmonary Embolism was suspected with anuria and septicaemia, the initial treatment, given was Ecosprin, Clopigerel, injection Heparin and Dopamine. Thereafter, for further treatment patient was referred to Cardiology Department at Dayanand Medical College (the Opposite Party No. 3). She subsequently, developed DIC and septicemic shock with multi organ failure. The patient died on 12.09.2005 due to sudden cardiac arrest.

About DVT and Pulmonary Embolism:  (Harrison’s Internal Medicine) and the medical literature on the subject, wherein it has been observed as under:-

Deep Vein Thrombosis (DVT) is a condition that happens when a blood clot forms in a deep vein, usually in the leg. DVT can occur when sitting or lying down for long periods of time, such as during recovery from Surgery or during a long airplane flight. The Pulmonary Embolism (PE)happens if the clot breaks off and travels through your bloodstream to the lungs. The clot can block a blood vessel leads to low oxygen levels in blood. That it can damage the lung and other organs and cause heart failure too. Depending on the symptoms the patient was treated with thrombolytic drugs. Once the diagnosis of DVT or PE made, the goal is to shrink the clot and prevent other clots from forming. An anticoagulant is a type of blood thinner that slows blood clotting. Two types of anticoagulants are Warfarin and Heparin. The doctor may give thrombolytics to break up the clot very quickly. Such type of medication be given in a hospital, often in an emergency room.

Prophylactic measure is increasing the amount of ambulatory movement for postoperative patients. Walking increases the amount of blood flow in patients, leading to a decreased probability of blood clot formation. Additionally, intermittent pneumatic compression (IPC) can be used for patients who are wheelchair or bed-bound. Due to a relative lack of mobility and dehydration, DVT and PE may occur among people traveling on long airplane flights. 

Findings: Post-operatively to avoid infection, the Opposite Party No. 1 administered higher antibiotics viz. Augmentin, Amikacin and pain killers. Patient was also advised for early ambulation.. During postopreative period  the patient was afebrile, taking oral feeds, passing the stools. On 10.09.2006 the patient was discharged in stable condition. The Pulmonary Embolism is very fatal condition developed in the instant patient and it caused multiorgan failure (MOF) and subsequently death. However, in our view, septicemia appears to be a provisional diagnosis made by the Opposite Parties Nos. 2 and 3.   We allow these Revision Petitions and dismiss the Complaint.

About the author

Anoop K. Kaushal

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