Kerala hospital, ENT surgeon ordered to pay ₹30 lakh compensation 21 years after patient’s death

In 2001, the patient had undergone septoplasty, a corrective surgical procedure for straightening the nasal septum. Two years later, he succumbed to complications triggered by the surgery.

BySumit Jha

Published Mar 11, 2024 | 8:00 AMUpdatedMar 11, 2024 | 8:00 AM

Kerala hospital, ENT surgeon ordered to pay ₹30 lakh compensation 21 years after patient’s death

The Kerala State Consumer Dispute Redressal Commission has ordered an ENT surgeon, anesthesiologist, and a hospital in Kozhikode to pay a compensation of ₹30 lakh to the family of a man, who had died 21 years ago following an alleged botched surgery.

The patient, Abdul Rehman of Malappuram, underwent the surgery on 4 April 2001 to correct a nasal deformity under the supervision of Dr Johnson Marion of the Nirmala Hospital.

Though septoplasty to straighten the bone and cartilage between two nasal cavities was a normal procedure, Rahman failed to regain consciousness post-surgery. Despite assurances, complications escalated, and he was put on ventilator support. The man remained in Nirmala Hospital till 16 April 2001 with no improvement.

The hospital allegedly refused to heed his relatives’ request for medical records to transfer him to a better medical facility.  Dr Marion later agreed to release the patient to shift him to Manipal on 16 April.

However, Rehman’s condition remained the same despite undergoing treatment at the Kasturba Hospital in Manipal, where he was admitted on April 17. He was in Kasturba Hospital till 12 May  2001.

Doctors at Kasturba Hospital concluded that no further action could be taken, and Rehman was advised to continue treatment locally. Diagnosed with hypoxic, hypoxemic encephalopathy, and a persistent vegetative state, he was subsequently transferred to Al-Shifa Hospital in Perinthalmanna for ENT, head, and neck surgery.

Despite three months of treatment, his neurological status showed no improvement. Discharged with instructions for home care, Rehman continued to receive support at home, including tube feeding and catheter.

“At the time of surgery, Abdul was only 33 years. He was employed in Qatar, earning around ₹25,000 per month. He was healthy and had no ailments. He was married and had two children, the elder daughter was six and the younger son 8 months,” his wife Rasheeda said her complaint to the commission.

The family contended that negligence during Rehman’s elective surgery, similar to a cosmetic procedure, led to avoidable complications. They stressed that the surgery, under general anaesthesia, was deemed appropriate, with no indications of contraindications. Any concerns about Rehman’s fitness should have prompted the hospital to postpone or avoid the procedure.

Despite requests, the hospital withheld the case sheet, they claimed, adding that the doctor provided a letter on 9 July after they warned him of legal consequences. The letter stated that the surgery was uneventful, but was followed by cardiorespiratory arrest, hypoxic brain damage, and seizures.

The complainants challenge the letter’s accuracy, citing contradictions in the hospital’s reply given on 18 July, acknowledging a failure in post-surgery recovery.

Both the anesthesiologist and hospital admitted that Rehman’s condition was due to surgical complications. The complainants argued that the hospital implicitly accepted liability by not issuing a bill or demanding further payment.

Also Read: Kerala man lost vision after nose surgery, doctor asked to pay ₹1 lakh

Relatives lodge police complaint

On 9 September 2001, a police complaint was lodged, which was later forwarded to the Assistant Commissioner of Police in Kozhikode. The police seized records months later, raising suspicions of tampering.

The complainants petitioned the Judicial First Class Magistrate. The court, on 2 November, issued an order to provide a photostat copy of the record. An examination confirmed that the document had been tampered with, especially, pages 29 to 33. It suggested a lack of documentation for about 30 minutes post-surgery.

The case sheet indicated Rehman’s transfer to the recovery room at 10:55 am in good condition, followed by entries revealing restlessness, cyanosis, and vital signs of deterioration within five minutes. These revelations bolstered the complainants’ allegations of negligence during the postoperative phase.

They asserted that irreversible brain damage resulting from a lack of proper care during the critical period resulted in Rehman’s comatose. The conflicting entries, they said, pointed at negligence during the surgery.

Pulmonary edema, without a specified cause, was highlighted, potentially from postoperative aspiration. The complainants questioned the absence of reasons for the alleged cardiorespiratory arrest, attributing it to inadequate recovery from anaesthesia, over-sedation, or aspiration.

They alleged that improper anaesthesia administration and surgery had led to cardiorespiratory arrest. The incident inflicted hardship on Rehman’s wife and children, depriving them of companionship and support.

Rehman died on 31 August 2003.

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The hospital’s version

Refuting the allegations, the ENT surgeon and anesthesiologist said the surgery was uneventful, and the patient was awake and conscious upon extubation.

Acknowledging the unexpected cardiorespiratory arrest and subsequent seizures, the medical team said resuscitation and ventilator support were initiated promptly. They recommended conservative treatment, collaborating with a neurologist. They also refuted allegations of negligence during postoperative care. The patient’s transfer to Manipal on 16 April 2001 was facilitated based on his relatives’ request.

The doctors said that septoplasty under general anaesthesia was not a minor surgery and denied keeping the patient in the dark.

Denying allegations regarding a lack of communication with the patient’s relatives, the doctors asserted that the surgery’s successful completion was communicated around 10:50 am, contradicting the complainants’ assertion of no information until 11:30 am.

They countered claims of delayed indication of post-surgery complications, insisting that the patient fully recovered from anaesthesia and communicated before he was transferred to the recovery room.

They also denied rejecting transfer requests and emphasised agreeing to a referral when the patient’s condition stabilised. Dismissing malafide motives, they said a reference letter was provided when the patient was transferred to Manipal.

Refuting claims of deficient service, negligence, and unfair trade practices, the medical team argued that the patient’s condition was a known complication of procedures under general anaesthesia. They clarified the corrective nature of the surgery, challenging the characterisation of it as mere cosmetic.

They denied any tampering of records, emphasising the provision of a comprehensive reference letter at the time of the patient’s transfer to Manipal. The anaesthesia chart detailed the patient’s condition post-surgery, indicating wakefulness, coherent speech, and intact protective reflexes.

The medical team rejected the complainants’ narrative of events after 10:20 am, explaining the gradual weaning off of anaesthesia with necessary procedures performed by the ENT surgeon.

The hospital, meanwhile, disputed the sequence of events, asserting the patient’s full recovery post-surgery, with a cardiorespiratory arrest detected and promptly treated in the recovery room.

Also Read: Kerala consumer court orders patient to pay compensation to her doctor

The commission’s observations

The commission in its judgement observed that the surgery was not necessitated by any disease or medical condition. It said that the evidence adduced by Witness Dr MP Manoj, an ENT surgeon is crucial.

It found that Rehman was left in a vegetative state due to a lack of constant monitoring.

The commission said that it was clear that vital parameters were not recorded during the crucial period. “It is claimed that there was close monitoring of the condition of the patient. But, there is no evidence to support the said contention. Going by the case sheet, what emerges is that no monitoring of the patient was done from 10.30 am to 10.55 am,” it said.

“There is no recording of monitoring regarding the vital parameters of the patient during that time. In the absence of any such evidence, the only conclusion possible is that there was no monitoring of the condition of the patient during the crucial period that changed his entire life. Though it is seen recorded that the patient was conscious till 10.55 am that can even be a deceptive impression and cannot support the conclusion that the vitals of the patient were normal. It is for the said reason that five minutes thereafter the patient had become cyanosed–when patients skin, lips and/or nails turn a bluish tone,” the commission observed.

Dr Manoj said a patient would require more than three to four minutes to become cyanosed. It is a gradual process that could be easily identified if there is constant monitoring. Dr Manoj further said that the complication of irreversible brain damage is not a surgical issue, but a possible delay in identifying the complication. It is a monitoring issue.

“The above statements expressing definite opinions formed by Dr Manoj after examining the case sheet have not been seriously challenged or disproved by the opposite parties in this case. Therefore, we have no hesitation in concluding that the vegetative condition of Abdul was caused as a direct result of the monitoring lapse on the part of the doctors and hospital after the surgical procedure was completed,” the commission said while ordering the compensation.