Justice for Adhesion - ARD - Patient in India - negligence case

From: Dr. David Wiseman (david.wiseman@adhesions.org)
Sat May 5 10:02:03 2012

http://articles.timesofindia.indiatimes.com/2012-04-17/chennai/31354829_1_ap pendicitis-surgery-stomach-pain-small-intestine

CHENNAI: In November 2002, R Venkataraman, a medical representative from Salem, was admitted to Kiruba Hospital in Salem as he suffered from acute stomach pain. Many surgeries later, Venkataraman was finally discharged on March 30, 2003, but died the same day as he developed breathing difficulties and low blood pressure.

His wife Lalitha and children Ramachandran and Priyanka filed a complaint before the state consumer disputes' redressal commission (SCDRC) charging authorities of Kiruba Hospital with gross medical negligence. Now, the SCDRC has passed an order in their favour, directing the hospital to pay 5 lakh as compensation to the family. "We filed the petition in June, 2004. Though the case came up every month since then, evidence was recorded on two days and arguments were held only on one day, out of the 95 hearings. The judgment was delivered seven years and eight months later. This is nothing but a mockery of the judiciary as the consumer courts were set up for speedy disposal of cases, but now this has been defeated," said Dr K Swaminathan, faculty member at IIT-Madras, who was closely associated with the case. In their complaint, the petitioners said Venkataraman had undergone a surgery for appendicitis the month before he had stomach pain, but doctors at Kiruba Hospital did not verify whether the pain could be because of a retained appendix or adhesion of the small intestine, which can happen in the aftermath of an appendicitis operation.

As a result, on performing a laparoscopy, doctors did not find any signs of appendicitis, but noticed adhesion instead. In order to resolve the issue, they opted for a laparotomy - an open surgical procedure - immediately afterward but failed to pay attention to tears in the intestine which are likely to occur while the adhesion is being released.

Due to this, fluid collected in the abdomen which led to swelling, prompting the doctors to perform a second open surgery on him. They then left part of the abdomen open to clean the leaking fluid, but during this phase, his blood pressure fluctuated erratically and there was absence of urine or stools. He was left in this state from November 4 to December 26, 2002. Since he could not walk freely and as there was no improvement of his health, his relatives decided to take him out of the hospital and seek treatment in Chennai.

While passing orders, the bench observed that doctors at the hospital had failed to consult an expert even when the patient's condition did not improve. Pointing out that doctors at Kiruba Hospital had failed to recognise and analyse the possibility of intestinal adhesions since the patient had undergone appendicitis surgery, the bench said in not taking the appropriate precautions or conducting necessary preliminary investigation, but straightaway going in for laparoscopy should be construed as negligence since there is the possibility of causing injury to the intestine which appears to have had taken place in this case.

"There is no explanation or details, as to whether they have treated the perforation, accordingly. Merely ignoring it as if it will heal on its own, they have closed the surgical wound alone. This, in our opinion, should be construed as negligence," the consumer commission said.


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