Surgeon knows better

  • Posted on: August 05, 2021

Is it mandatory to send tissue for histopathological examination (HPE) for every case, every time? Medical science and law both say that it is the surgeon’s prerogative.

The patient, a teenage girl, approached the hospital with complain of severe back pain. The surgeon examined her, performed MRI and X-ray, and diagnosed L4 L5 disc prolapse. He performed laminectomy and the patient was discharged after few days.

However, the pain in her back did not subside. She visited the surgeon after about two months with same complain. The doctor suspected Koch’s spine and sent the biopsy sample for HPE. In the meantime, the patient visited another doctor and got admitted to another hospital where tuberculosis (TB) of spine was confirmed. She received treatment at this second hospital and was alleviated of back pain.

Perhaps the patient’s father suffered more pain than she did, as he sued the surgeon and hospital. His main allegation was that the doctor ought to have sent the sample for HPE at the first instance to confirm TB.

The Commission rejected this contention and stated the following:

“It is pertinent to note that MRI and X-ray spine did not show any abnormality or signs of TB, therefore clinically TB spine was ruled out. Thus, in our considered view sending of the removed disc piece did not make any adverse effect, as the biopsy sent at later stage was negative for TB”.

“In our view, the patient failed to prove that she was suffering from Koch’s Spine at the time of admission. Secondly after laminectomy as per standard surgical practice, it is not mandatory to send the disc material for HPE. The operating surgeon shall decide it on the basis of clinical surgical findings whether there is any need for HPE”.

The case against surgeon and hospital was dismissed.

Source: Order pronounced by National Consumer Disputes Redressal Commission on 14th June, 2021.