The Commission noted the lack of a biopsy supporting the assertion of necrotic tissue, casting doubt on the necessity of the procedure.
Published Feb 16, 2024 | 8:00 AM ⚊ Updated Feb 16, 2024 | 8:34 AM
The Commission awarded the patient ₹6 lakh as compensation. (Creative Commons)
After 18 long years, a woman, who underwent unnecessary removal of her left ovary and fallopian tube at the tender age of 11 in 2006, has finally been granted compensation of ₹6 lakh.
On 24 January, 2024, the Telangana State Consumer Disputes Redressal Commission emphatically dismissed an appeal filed in 2018 by the doctor who performed the surgery, challenging the Karimnagar District Commission’s order for compensation that came 10 years after the complaint was filed — on 24 January, 2018.
The District Commission had, in 2018, ascertained the doctor and a nursing home’s culpability for inducing functional disability in the patient through the unnecessary removal of her left ovary and fallopian tube, without proper pre-surgery assessment. Despite acknowledging the potential for a reduced compensation amount, the Commission upheld the awarded sum of ₹6 lakh as justifiable.
In 2006, an 11-year-old girl from Karimnagar, Telangana, grappled with excruciating abdominal pain, leading to her admission to Surya Nursing Home. After an abdominal ultrasound, Dr Ch Ravinder Rao conducted an exploratory laparotomy, based on identified issues.
Exploratory laparotomy is a surgical procedure where the abdominal cavity is opened to visually inspect and assess organs, often performed in emergencies or when the cause of abdominal issue is unclear following non-invasive diagnostics.
Unfortunately, her abdominal pain persisted, necessitating her return to Dr Rao’s care a month later. During this second visit, she endured a two-hour laparotomy. Shockingly, a month later, she claimed that her left fallopian tube and ovary, crucial reproductive organs, were removed without her family’s knowledge during the laparotomy.
Seeking relief from ongoing pain, she underwent a third surgery in Hyderabad. Notably, the persistent abdominal pain was reportedly unaddressed during the initial two surgeries performed by the doctor. It is while seeking a solution for the third time at another hospital that it was brought to her notice that her left ovary and fallopian tube were not visualised in the ultrasound scan.
Dr Ravinder Rao acknowledged that the complainant, a minor, sought medical attention for abdominal pain, leading to admission at Surya Nursing Home.
Following an ultrasound and exploratory laparotomy, she returned a month later with persistent pain, leading to a referral for another ultrasound. Diagnosed with hematometra (retention of blood in the uterus) of the left horn of the uterus, a subsequent laparotomy was performed, excising necrotic left ovarian tissue with proper consent, the surgeon claimed in his appeal.
He added that the patient’s parents were advised to seek further management in Hyderabad for congenital anomalies. Dr Rao asserted the absence of negligence or mistakes in the operations, and requested the dismissal of the complaint as unfounded.
After a thorough examination of the evidence presented, the Karimnagar District Commission partially upheld the complaint. The ruling instructed the doctor and nursing home, acting jointly and severally, to pay the complainant a compensation amounting to Rs.6,00,000.
After a thorough examination of the evidence presented, the Karimnagar District Commission partially upheld the complaint. The ruling instructed the doctor and nursing home, acting jointly and severally, to pay the complainant a compensation amounting to ₹6 lakh, with an interest of 9 percent per annum from the date of filing of the complaint — 10 November 2008 — till realisation.
The doctor and the nursing home, dissatisfied with the District Commisssion’s decision, filed an appeal, asserting that the Commission failed to consider crucial evidence.
They argue that the complainant, the young girl, had a mass on the left fallopian tube and ovary, compressing the uterus, with suspected congenital defects such as a dermoid cyst or twisted ovarian cyst with internal thrombus.
They also alleged that the girl left the hospital against medical advice, later diagnosed with “Bicornuate Uterus with Hematometra in Left Horn — Rudimentary Horn/Imperforate” during a subsequent visit.
A bicornuate uterus is a congenital uterine anomaly characterised by a heart-shaped or two-horned structure, resulting from incomplete fusion of the Müllerian ducts during foetal development, potentially impacting reproductive health with an increased risk of complications such as miscarriages and preterm births.
The appeal emphasises the larger left side of the bicornuate uterus, inability to pass the uterine sound, aspiration of clotted blood, and removal of necrotic ovarian tissues during the laparotomy.
Dr Rao and the nursing home defended the removal of the diseased left ovary during the second surgery to prevent recurrent problems, in the patient’s best interest.
After carefully considering the case, the Telangana State Consumer Disputes Redressal Commission took into account various medical records, including ultrasound reports and laparotomy findings. It recognised that the patient was diagnosed with a bicornuate uterus with hematometra in the left horn, a congenital condition that warranted surgical intervention.
The Commission concluded that the surgeon did not sufficiently take into account pre-surgery ultrasound reports, resulting in the unjustified removal of the patient’s left ovary. This lapse was identified as a case of medical negligence and a deficiency in service.
Additionally, the Commission emphasised the lack of a biopsy report supporting the assertion of necrotic tissue, further casting doubt on the necessity of the surgical procedure.
“In his written version, the doctor has submitted that ‘Laparotomy was done through the same old incision. Uterus enlarged bicornuate, left horn tense thick, remains of left ovary were small necrotic? Gangrenous. Necrotic left ovarian tissue’. However, this is not supported by the ultrasound report nor does the discharge summary support the findings,” the Commission noted.
It added, “If he thought that the left ovarian tissue was necrotic or gangrenous, then it should be supported by a biopsy report and it needs to be diagnosed by blood tests. This reveals the deficiency and negligence of the doctor. He conducted the two procedures without due care and skill, and further removed the young patient’s left ovary and fallopian tube without the necessary preliminary tests to confirm the necrosis or that the gangrenous tissue was cancerous.”
The state Commission also observed that the doctor and the nursing home contended that consent was obtained for passing the uterine sound to drain the hematoma, a fact acknowledged by the respondent/complainant during their deposition.
However, the complainant maintains that no consent was sought for the removal of the left ovary and fallopian tube. “This aspect needs to be reiterated and emphasised,” the state Commission observed.
