Ortho surgeons performing spinal surgeries? This case may ruffle the feathers

  • Posted on: 1st June, 2023

The patient was diagnosed with kyphoscoliosis – a spinal deformity – at the age of twelve in 2004. A non-malignant tumour was also reported, which could only be partially resected.

Over the next decade the tumour’s size shrunk. But the boy had difficulty in sitting for long period of time, among other discomforts.

His parents consulted two hospitals, both opined that there was only 50 – 60% chance of correcting the scoliosis. Worried about their ward’s future, they consulted an orthopaedic surgeon at a reputed private hospital. He opined that there was 80 – 90% chance of recovery.

The patient and his parents agreed for surgery. However, their hopes were shattered beyond imagination.

Post-surgery, the patient developed paraplegia. He was shifted to ICU; several tests were performed. To add to the woes, he was diagnosed with pyogenic meningitis.

The patient was referred to another hospital where he remained admitted for a little over six months. But there was hardly any improvement in his condition.

The orthopaedic surgeon and hospital were sued. It was alleged that the doctor did not disclose the risks of surgery and did not take a proper consent. It was also alleged that he presented a rosy picture about his surgical skills and benefits of using neuro-monitoring machine during surgery – which was not used at all. Even a neurosurgeon was not consulted, claimed the boy’s parents.

The doctor and hospital simply narrated the intra-operative and post-operative accounts.

The Commission perused medical records and found glaring lapses on part of the doctor and hospital, observing the following:

“I have perused consent forms and operating surgeon’s prescriptions. The consent for operation lacks the ingredients of informed consent. The risks of paraplegia during kyphoscoliosis surgery were not mentioned or explained. The documents on record are unsigned prescriptions which in my view does not construe as informed consent”.

“It is pertinent to note that patient’s spinal tumour was operated in his childhood – in the year 2004. After span of one decade, in 2014, the spinal scoliosis correction surgery was performed by orthopaedic surgeon. Therefore, in my view, prior to surgery it was his duty to perform nerve conduction studies and neurological assessment. It was also necessary to seek opinion or assistance of a competent neurosurgeon before and during the surgery

“The role of orthopaedic surgeon in spinal surgery is restricted to the bony structure or correction of deformity but if there is neural tissue involvement, then the operating team shall consist a neurosurgeon. Moreover, usually patients with congenital scoliosis have spinal cord malformations also. The best age for corrective surgery is 18 years, but it was not very conducive for a patient who was 22 years old unless it was life-threatening. In the instant case the doctor did not seek opinion of neurosurgeon before putting the patient under knife”.

“Admittedly, patient’s parents had chosen the hospital for proposed spinal surgery where neuro-monitoring machine was available and it was emphasized by the doctor that its use prevents any damage to the spinal cord during surgery. It is pertinent to note that the surgery was postponed by a week as the neuro-monitoring machine was under repair. The hospital failed to provide the purchase invoice, installation report, training record of the technician who operated neuro-monitoring machine used during the surgery. They deliberately concealed annual maintenance contract (AMC) service report of the machine which was used; but filed AMC service report of the machine which was not used during the surgery. Also, the statements of the neurotechnologist and neurophysiologist were contradictory to each other about the neuro-monitoring and interpretation of its reports. Moreover, the qualification of neuro-technician raises many doubts”.

The hospital and orthopaedic surgeon were held negligent, and ordered to pay forty lakh rupees compensation to the patient.

Source: Order pronounced by National Consumer Disputes Redressal Commission on 19th December, 2022.