The National Consumer Disputes Redressal Commission (NCDRC) recently cleared a hospital and two doctors in Uttar Pradesh of allegations of medical negligence in a case involving a patient who suffered complications after receiving spinal anesthesia before undergoing laparoscopic cholecystectomy. The case was brought forward by a patient who alleged that the anesthesia procedure had caused her permanent disability, specifically in her right leg. Although the State Commission had earlier ordered the hospital to pay substantial compensation to the patient, the Apex Consumer Court dismissed the ruling, citing key evidence such as an MRI report and expert testimony provided by the Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI).
The case's origins can be traced back to 2014 when the patient experienced sudden abdominal pain and consulted a doctor. After conducting tests, the doctor recommended an ultrasound of the abdomen and pelvis. The ultrasound report indicated "cholecystitis with echogenic gall bladder sludge" and also noted a "small left renal concretion." Following this diagnosis, the patient was admitted to Opal Hospital, where the treating doctor advised laparoscopic cholecystectomy, a procedure to remove the gallbladder.
On the day of the surgery, spinal anesthesia was administered to the patient. According to the patient, she felt an immediate, sharp, electric shock-like sensation in her right leg when the anesthetic needle was first inserted. The anesthesiologist withdrew the needle and attempted to administer the anesthesia again, but the patient experienced the same sensation a second time. Despite this, the staff restrained the patient, and the needle was inserted for a third attempt. Following the administration of anesthesia, the surgery was performed without any complications. However, after regaining consciousness, the patient found herself unable to move her right leg, although the rest of her body appeared to function normally.
The patient claimed that she repeatedly informed the doctors about her inability to move her right leg, but they did not respond with any urgency. After the catheter was removed, it became evident that the patient had lost sensation in her right leg, which had become virtually paralyzed. An orthopedic surgeon was consulted, but there was little improvement in her condition. At this point, the patient's husband sought the opinions of Dr. Rakesh Singh, a neurosurgeon, and Dr. D.K. Singh, an anesthesiologist. After examining the patient, Dr. Rakesh Singh observed that she was unable to walk, could not properly place her right foot on the ground, and had no sensation in her foot.
From the MRI report, no one can say that the lesion is because of spinal anaesthesia and cannot be reversed back.
NCDRC ruling
An MRI of the patient's lumbosacral spine was recommended, and the report showed focal increased intramedullary signal intensity in the conus medullaris at the D12-L1 level, as well as early lumbar spondylosis with mild subluxation of the L4 over L5 vertebral body. The MRI also revealed some disc issues and mild neural foraminal encroachment, but there was no clear indication that the anesthesia caused direct damage to the spine. Despite undergoing treatment for several days, the lack of sensation in her right leg persisted, and she was discharged in that condition. The orthopedic surgeon who treated her at the hospital noted that she was suffering from a full right foot drop, a neurological disorder that sometimes occurs after spinal anesthesia.
Following her discharge, the patient sought treatment at several other hospitals, including BHU and Max Hospital in Delhi, but her condition did not significantly improve. As a result, she filed a formal complaint against the hospital and doctors, alleging gross negligence in administering the spinal anesthesia, which led to her permanent disability. The patient requested a large compensation for the physical, emotional, and financial damages she had suffered.
In response, the hospital and doctors denied the allegations of negligence. They referred to the MRI report, which did not conclusively link the spinal anesthesia to the patient's nerve damage. They further argued that the lesion detected on the MRI could not be definitively attributed to the anesthesia and might have been due to pre-existing conditions. The defence emphasised that there was some improvement in the patient's condition, as she could place her heel on the ground, although there was no response in her toes.
The State Commission has recorded adverse findings in this respect without there being any issue between the parties.
NCDRC ruling
When the case was initially heard by the State Commission, the court ruled in favor of the patient, finding that there had been a breach of standard medical procedures. The State Commission observed that the common practice in anesthesia was to abandon the spinal injection if the patient experienced an electric shock sensation on the first attempt. However, in this case, the anesthesiologist had proceeded with three attempts, despite the patient's complaints. The court also noted that there was no separate consent form for the administration of anesthesia, which further raised questions about the hospital's practices. As a result, the State Commission ordered the hospital and doctors to pay Rs 15 lakhs in compensation, along with other financial penalties for the patient's medical expenses, pain, and suffering.
Unhappy with this ruling, the hospital and doctors appealed the decision to the NCDRC. Upon reviewing the case, the Apex Consumer Court found several discrepancies in the State Commission's ruling. The NCDRC noted that the MRI report did not clearly indicate that the spinal anesthesia had caused the patient's neurological condition. Additionally, the expert opinion from SGPGI did not provide any conclusive evidence regarding the number of times the anesthesia needle should be inserted or whether multiple attempts could lead to nerve damage. The court also pointed out that the patient had signed a composite consent form, which included both the surgery and anesthesia, and there was no specific issue raised at the time regarding informed consent.
The NCDRC bench referred to previous Supreme Court rulings, including Samira Kohli v. Dr. Prabha Manchanda and M.A. Biviji v. Sunita, which set precedents regarding medical consent and negligence. In these cases, the courts had emphasized the need for clear and definitive evidence of negligence before ruling in favor of the complainant. In the present case, the NCDRC found that the State Commission had ignored the expert opinion provided by SGPGI, which did not support the claim of negligence. Moreover, the court observed that there were no allegations of negligence during or after the gallbladder surgery itself, and the complications were solely related to the administration of anesthesia.
Ultimately, the NCDRC concluded that there was insufficient evidence to prove that the hospital and doctors were negligent in administering the spinal anesthesia. As a result, the court set aside the State Commission's ruling and exonerated the hospital and doctors from all charges of medical negligence.
(Input from various sources)
(Rehash/Yash Kamble/MSM)
