Case Study

Huge Fibroids during Hysterectomy

decided by the Hon’ble NCDRC on : 17 Nov 2021

FACTS: Smt. Sudhamala (since deceased, the ‘patient’) underwent hysterectomy operation on 12.06.2009, under spinal anesthesia by Dr. Hema Raghu Chitneni  at Nitya Sai Emergency and Maternity Hospital and Opposite Party No. 2, Dr. Santosh Patil, an Anesthetist gave fitness for the surgery. It was alleged that after one hour of commencement of the operation, the Opposite Party No. 1 came out of the operation theatre and informed that the patient developed heavy bleeding and cardiac arrest, patient was shifted to Apollo Research Hospital, Karimnagar for ventilator support and better facilities, that doctors therein   informed that the patient was already brain dead and in spite of ventilator support and Cardio-Pulmonary Resuscitation (CPR), the condition of patient did not improve and she died in the early morning on 13.06.2009.  In the Death Certificate the cause of death was stated as “post abdominal hysterectomy leading to sudden cardio pulmonary arrest with multiple organ failure”.

DEFENSE: That on 12.06.2009 at 5:30 p.m. during the operation, huge fibroids were found which were shown to the patient’s husband and the doctor explained the risk of proceeding further, which the husband of patient accepted. At about 7.30 p.m., the patient suffered a cardiac arrest. Every possible step (CPR) to revive the patient was taken. For further cardiac management including ventilatory support, she was shifted to Apollo Hospital in an ambulance accompanied by the Opposite Parties Nos. 1 & 2.  There was no negligence on the part of the Opposite Parties and the death of patient was due to cardiac arrest.

OBSERVATIONS: The Medical Record and the operative notes revealed us that admittedly on 12.06.2009 the patient underwent hysterectomy operation at about 5.30 pm, there was huge fibroid. Post-operatively at 7.30 p.m. the patient suffered cardiac arrest.  Though, the patient was transfused 2 units of blood but the BP was not recordable, pulse was feeble. The doctors initiated CPR. The blood was continued, oxygen supply was continuous and the Dopamine dip was started. Injection Atropine and Adrenaline were given. The patient was intubated and connected to Boyle’s and ventilation continued. At 8.00 p.m. the doctors noticed   the patient was not responding painful stimuli. As the ventilator support facility was not available in the Opposite Party No. 3 hospital, the patient was shifted to higher center Apollo Hospital for the further cardiac management with the Ambu-bag and O2 support. At Apollo Hospital the relatives of the patient were explained about the serious condition of the patient, the doctors continued the resuscitation as per ACLS guidelines; however, the patient could not survive and declared dead at 2 a.m. on 13.06.2009.

HELD: We would like to rely upon the catena of judgments from Hon’ble Supreme Court which held that the medical practitioner cannot be held liable for medical negligence simply because the things went wrong as long as the doctors performed their duties with ordinary degree of professional skill and competence. We further note that the AP Medical Board appointed an expert Committee consisting of two doctors – Professor and Head Forensic Medicine   namely, Dr. Surender Reddy, from Gandhi Hopsital, Secunderabad  and Dr. M. Narayan Reddy  from Osmania General Hospital, Hyderabad who in their report, dated 17.11.2009 opined that there was no negligence of the operating doctors. In the instant case we are of considered view that the doctors followed the reasonable standard of care and there was neither deviation nor deficiency in service during operation or handling the post-operative complication. Considering the entirety of the case the Complainants failed to prove their allegations of excessive anesthesia or excessive bleeding during the operation. Based on the foregoing discussion, the Complainant failed conclusively to prove that the treating doctors were negligent. We concur with the Order of the State Commission, which requires no interference. The instant First Appeal is dismissed.

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