Obtaining implants for surgery could be a logistical problem, observes court

  • Posted on: July 11, 2024

The patient had a long history of tightness of lower limb, difficulty in walking, and also suffered from urinary issues and erectile dysfunction. He was taken to the hospital, where the doctor diagnosed cervical spondylitis with myelopathy.

Cortectomy was performed by a team of doctors. The patient recovered well, and was discharged after some days.

Soon thereafter, the patient experienced sharp pain in the back, shoulder and neck. He was readmitted so that the bone graft could be replaced with plate. However, the surgery could not be performed for ten days due to non-availability of the plate. It was further delayed due to medical complications.

The patient suddenly vomited lot of blood; he unfortunately died due to hematemesis and cardiac arrest.

His family sued the doctors and hospital. There were many allegations, but their main contention was two-fold – rather than bone grafting, the doctors ought to have inserted plate during the first surgery itself, and there was a delay in performing second surgery even though the graft was protruding which was causing complications.

The doctors and hospital denied these allegations, and presented medical records, medical texts in their defence.

The Commission perused these documents, considered opinion of an independent medical board and observed the following:

“On careful perusal of medical record, on readmission there was no neurological deterioration following surgery and therefore, no possibility of graft displacement. Thus, it would not any way be a life-threatening condition. The delay of re-surgery was due to patient’s other medical problems like anaemia, fever and collar sore close to the site of surgery. Therefore. placing a plate i.e., a foreign body in cervical spine was additional risk of infection and non-healing of wound. We further note that the patient suddenly vomited copious quantity of fresh blood approximately 1.5 litres for few minutes. His death was due to cardio-respiratory arrest because of massive hematemesis. In our view, such hematemesis was not due to injury by graft protrusion, but it was more likely to be due to peptic ulcer or oesophageal varices resulting from chronic liver disease.” 

“The allegation that surgery was postponed because of non-arrival of plate is not sustainable. It should be borne in mind that different sizes of cervical plates, and depending upon the height of vertebra and the graft length of cervical plate was determined. A lot of long plate holding devices, plate fixing devices, screw drivers and distracters are required for the procedure. The whole equipment is expensive and comes in a large, heavy box that has to be transported from elsewhere. Thereafter, autoclaved plates of various sizes are necessary for surgery. Thus, emergency surgery was not possible, and risk versus benefit is to be considered in such cases.”

“Moreover, the entire set of instrumentation is very expensive and every company has their own set and sizes of plates and matching instruments. Thus, most of the hospitals get the equipment on lease whenever surgery for anterior cervical plating is required rather than purchasing the equipment. It was neither possible to decide the size of the plate pre-operatively nor is it possible to keep ready all sizes of the plates.”

With these detailed observations, the Commission concluded that the doctors and hospital were not negligent, and case against them was dismissed.  

Source : Order pronounced by National Consumer Redressal Commission on 1st December, 2022.