Kerala man lost vision after nose surgery, doctor asked to pay ₹1 lakh compensation

The patient sought a solution for nasal blockage, but sustained damage to the left optic nerve and left medial rectus during the procedure.

BySumit Jha

Published Mar 09, 2024 | 11:00 AMUpdatedMar 09, 2024 | 11:00 AM

Kerala man lost vision after nose surgery, doctor asked to pay ₹1 lakh compensation

The Kerala State Consumer Dispute Redressal Commission has asked an ear, nose, and throat (ENT) surgeon and a hospital in Alappuzha to provide ₹1 lakh as compensation alone for the vision loss suffered by a patient following a polypectomy procedure.

The patient was seeking a permanent solution for nasal blockage, but allegedly sustained damage to the left optic nerve and left medial rectus during the procedure.

Previously, the district consumer court instructed the doctor and hospital to cover ₹51,000 in medical expenses of the patient, a decision upheld by the state consumer court.

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The case

In July 2011, Unnikrishnan Nair sought medical consultation from Dr Raju George, an ENT surgeon at Sahrudaya Hospital in Alappuzha.

Following a two-day prescription of medicines, the doctor recommended a polypectomy surgery for permanent recovery after a thorough examination.

The surgery took place at Sahrdaya Hospital, with which the ENT surgeon was affiliated.

On the evening of the surgery, the patient’s attender observed swelling in the patient’s left eye, which they reported to the doctor.

Upon examination, Dr Raju George assured them that the swelling was a temporary side effect of the surgery and would go down within a day.

However, the patient claimed to have lost vision in the left eye the following evening.

With assurances from the doctor that the issue would be resolved in a few days, the patient was discharged on 3 August, 2011.

He was initially admitted to the hospital with a breathing problem, but post-surgery, he experienced watery discharge from the nostrils, loss of vision in the left eye, and severe pain.

Seeking further medical attention, he consulted Dr Dalia, an ophthalmologist at Medical College Hospital in Alappuzha, who diagnosed an injury to a vein leading to the eye during the previous surgery.

The patient underwent in-patient treatment at the Medical College Hospital for one week and later sought care at Little Flower Hospital in Angamaly, where various tests were conducted. The initial diagnosis at this hospital revealed “left optic nerve injury and left medial rectus injury”.

Accusing the treating ENT surgeon of negligence, Unnikrishnan claimed that the issues could have been prevented with more caution during surgery.

The patient filed a consumer complaint, citing negligence by and deficiency in service of both the doctor and the hospital.

Additionally, the patient lodged a criminal complaint against the doctor at a Judicial First Class Magistrate Court.

He sought ₹94,000 for treatment costs, ₹10.2 lakh for loss of earnings, and ₹1 lakh for pain and suffering.

Earlier, the district consumer court in Alappuzha directed the doctor and the hospital to pay ₹51,000 for medical expenses, ₹50,000 as compensation, and ₹2,000 as litigation costs.

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The doctor’s side

Challenging the district commission’s ruling, both the complainant and the doctor appealed to the state consumer court in Kerala.

The doctor and the hospital asserted that there was no deficiency in service, emphasising that the patient initially consulted for persistent nasal block and was treated for allergic rhinitis and nasal polyps with tablets and nasal spray.

When the issue persisted, the patient was advised to undergo polypectomy after thorough anaesthetic and medical examinations.

They said that the doctor observed minimal fullness in the left eyelid during surgery, leading to consultation with ophthalmologist Dr Venugopal. The patient experienced hematemesis, requiring a physician’s intervention for blood transfusion.

Subsequent post-operative care addressed ecchymosis of the conjunctiva, and the patient was discharged with prescriptions for antibiotics, anti-inflammatory drugs, vitamins, and nasal drops, they said.

The doctor argued that there was no negligence, emphasising that bleeding was a common occurrence in such surgeries.

Citing medical literature, the doctor explained that blood may enter the orbital cavity during nasal polyp removal, causing temporary issues like fullness and ecchymosis.

The doctor also pointed out the patient’s unknown bleeding tendency and affirmed that appropriate treatment was administered.

The state consumer commission reviewed both parties’ submissions and the records from the district forum.

It observed conflicting diagnoses between the discharge cards from Medical College Hospital Alleppey and Little Flower Hospital, indicating redness and deviation of the left eye and left optic nerve injury with a squint, respectively.

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The commission’s observation

The commission observed that the patient was readmitted to Little Flower Hospital for the correction of post-traumatic divergent squint, undergoing procedures such as RE MR Exploration and BE LR Recession on 31 August, 2010.

Additionally, the patient sought treatment from the ENT Department of the same hospital for issues related to the left sphenoid ostium, optic nerve prominence, and injury from the previous surgery at the sphenoethmoidal junction.

In the course of the investigation, the treating doctor approached ophthalmologist Dr Venugopal’s son to verify his father’s statements.

Dr Venugopal had previously testified that orbital haemorrhage during surgery could potentially cause injury to the medial rectus muscles, and detached bony particles — if present — might lead to optic nerve injury.

However, referring to the medical records, the commission noted that:

“…clear manipulation is seen in page sixteen of Exhibit B1. A paper is seen pasted on the bottom portion of the 16-page of Exhibit B1 which bears the details regarding the ophthalmologist consultation given to the complainant. But on further verification, it could be seen that this paper was affixed on the bottom portion of the sixteenth page above the original entries of the medical record. It is a clear case of manipulation. In the starting portion of the seventeenth page a correction is seen made by erasing the original entries.

A medical record is a contemporary document simultaneously prepared by the hospital authorities during the process of treatment. So there cannot be any possibility of pasting another sheet of paper. So this is a clear example of creating evidence so as to justify the negligent act done by the hospital authorities.

The opposite parties had set up a case that if a complication arose to the eye, it is up to the Ophthalmologist to look into the matter and an ENT surgeon is not liable for any such complications. But the materials on record would show that there was no ophthalmic consultation done at the crucial stage as claimed by the opposite parties for the reason that these entries are subsequently concocted by pasting another piece of paper in the medical record.

Exhibit B1 was in the custody of the hospital. So it is up to the hospital authorities to offer satisfactory explanation as to why manipulation was done in the said record.”

Holding the treating doctor liable, the Commission further noted:

“The evidence let in by PW2 and PW3 would convincingly establish that while conducting the surgery, a nerve injury was also resulted. The above fact is not ruled out by the 1st opposite party when the subsequent medical records, Exhibit A3 were shown to him.

When polypectomy is done there cannot be any possibility to cause an injury to the optic nerve since the optic nerve is located away from the nostrils. The doctor was trying to explain the possibility of causing injury to the optic nerve by saying that he was unable to see the internal organs as the surgery was done from the surface.

A doctor is expected to assess the internal organs when surgery is sought to be carried out. If the surgery was done in a proper manner, it would never result in causing an injury to the optic nerve and medial rectus.”

The consumer court concluded a calculated attempt to fabricate evidence by the doctor and hospital through forgery and manipulation of medical records to conceal negligence during the surgery.

This manipulation, involving pasting separate sheets, aimed to hide crucial entries indicating negligence and escape potential consequences, it observed.

The commission concluded that the doctor’s negligence caused the optic nerve and medial rectus injuries.

Given the complainant’s hardships, the initially awarded compensation of ₹50,000 was deemed insufficient.

The commission enhanced the compensation to ₹1 lakh, and granted an additional ₹10,000 as legal costs. The original medical expense award of ₹51,000 was affirmed.

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