Age-old procedure in the New Age? Yes, why not.

  • Posted on: December 22, 2022

The patient accidently slipped in the bathroom and hurt her back badly. She was taken to the hospital by her son – an anaesthetist.

Tests were performed at the hospital which reported collapse of D-10 and traumatic compression of D-11. The doctor at the hospital performed surgery. The patient remained admitted for about ten days after which her son sought DAMA.

For some reasons, the patient was taken home and after eight hours or so was shifted to another hospital. She was diagnosed with pleural effusion and TB. She was taken to yet another hospital after about fifteen days where she was diagnosed with osteoporosis and bilateral pleural effusion.

The doctor at this third hospital re-operated the patient with bone cement augmentation. Finally, the post-operative tests confirmed that the operation was successful.

Patient’s son, the anaesthetist, sued the first doctor who operated upon his mother. His list of allegations was long and numbing:

The doctor ignored patient’s hypothyroidism and osteoporosis. Only physician evaluation was done but pre-anaesthetic check-up was not done.
It was an elective operation, but the doctor never bothered to see the X-ray and MRI reports which showed disparity. The compression was at D-10 and not D-11. He never pointed out the said difference and was unsure about which segment to operate, thus it was blatant negligence.
Patient’s bones were weak and fragile due to severe osteoporosis as clearly depicted in X-ray, but the doctor never bothered to put bone cement. The cement augmentation is being used extensively and successful in spine surgery to date.
No X-ray of spine was taken for five days after surgery, which clearly shows doctor’s malicious intent in trying to hide a botched-up surgery by placing screws outside the pedicle into the lungs. The misplacement of screw was only revealed after patient developed pneumonia because of the screw perforating the lung.
The doctor misled and covered-up his mistake by blaming screw placement into the lung due to patient's osteoporosis and obesity.
After giving a patient hearing to the aggrieved anaesthetist, the Commission dismissed his allegations by making following observations:

“The doctor in his defence relied upon an article from the year 2000 and claimed that he has been carrying out the good old treatment method. As per the article, short segment fixation could be employed in a very small subset of patients with simple fractures, and those who were willing to wear a brace for four months. In our view the method of treatment adopted was an accepted medical practice. Pedicle screw fixation is widely used in spine surgery for numbers of indications and pedicle screw loosening is a common complication after spine surgeries.”

“As stated, the patient’s son informed the doctor about osteoporosis; we do not see he ignored it. For proper fixation he chose not to use cement augmented screws. For reinforcing the stabilization and healing, the doctor used locally available bone graft at the aforesaid screw-site. It was an age-old procedure of bone-strengthening better than use of bone cement. The old method was still in use and there is nothing on record to prove such method was legally abandoned or stopped”.

“It is pertinent to note that three screws were retained during second surgery, thus meaning that osteoporosis effect was not for the three screws! In our view, the mistake of patient's son was that he took premature discharge from the hospital and took the patient home first and then, after about eight hours got her admitted to the second hospital. The duty of care for patient by doctor reflects, as out of courtesy, the patient was regularly seen by his colleague at the second hospital.”

“The patient thereafter had developed hospital acquired respiratory infection with pleural effusion which turned out to be TB at the third hospital which cannot be attributed to the treatment given by the doctor.”

As observed by the Commission, the learning from this duel between two doctors is that a procedure cannot be termed wrong or inappropriate just because it is in use since a long time.

Source: Order pronounced by National Consumer Disputes Redressal Commission on 21st June, 2022.