In a precedence-setting order, the National Consumer Disputes Redressal Commission (NCDRC) has directed a Kolkata vascular surgeon and Nightingale Diagnostic and Medicare Centre Pvt. Ltd. to compensate Rs 75 lakh. The matter related to a minor patient who developed a 90% permanent disability after an Arterio-Venous Malformation (AVM) embolization surgery that resulted in the amputation of his right leg above the knee, allegedly due to negligence on the part of doctors.
The commission, which was headed by Presiding Member Subhash Chandra and Member AVM J Rajendra AVSM VSM (Retd), held the doctor and hospital jointly responsible for medical negligence. The ruling pointed to a lack of informed consent, misrepresentation of post-surgical complications, and failure to avail of alternative treatment.
Hospitals cannot escape liability
The NCDRC clarified that hospitals cannot escape liability by placing responsibility on independent consultants. If a procedure is performed on their premises, the hospital becomes liable for any negligence involved.
Case Review: A Teenager’s Battle with Medical Negligence
A Decade-Long Medical Journey
The patient in the case was a 17-year-old boy who had been showing swelling in his right gluteal area since 2000. The initial diagnosis by physicians was neurofibroma, and the family was reassured that nothing was wrong. With time, however, the swelling became more serious, and by 2014, a fine needle aspiration cytology (FNAC) revealed a potential diagnosis of angiolipoma.
In 2015, the family met Dr. Anirban Chatterjee, a surgeon who deals with vascular diseases, and who advised more diagnostic procedures. A CT angiography confirmed an Arteriovenous Malformation (AVM) on the right hip, after which the surgeon advised vascular embolization as the optimal treatment. The surgery was conducted at Nightingale Diagnostic and Medicare Centre Pvt. Ltd. on September 16, 2015.
Medical Negligence Allegations
After the embolization operation, a few drops of N-Butyl Cyanoacrylate (NBCA) glue spilled over into the artery of the right leg, closing off the main artery. The surgeon initially convinced the family that the issue was small and might be fixed the following day via a follow-up procedure. Regardless of a procedure on September 17, 2015, the patient soon developed gangrene as a result of impaired circulation of blood.
By September 19, 2015, the patient was shifted to Sir Ganga Ram Hospital in Delhi, where doctors determined that the condition had worsened rather than improved. On September 22, 2015, the patient underwent a life-changing surgery — amputation of her right leg above the knee.
The mother and patient approached the district consumer forum and filed a complaint under Section 21 of the Consumer Protection Act, 1986, alleging medical negligence for Rs 20.41 crore in damages. They claimed the doctors did not explore alternative modes of treatment, such as bypass surgery, and misled them regarding the intensity of the complications.
The surgeon and hospital defend
Dr. Chatterjee and the hospital have refuted the allegations, insisting that AVM embolization is a high-risk procedure with well-known complications. They explained that the family of the patient had signed a high-risk consent form, in which they had acknowledged the potential negative outcomes.
The surgeon insisted that:
The operation was carried out according to medical guidelines.
Alternative interventions, including bypass surgery, were impossible.
The glue ratio employed fell within normal medical protocols.
He personally arranged for the patient to be shifted to Sir Ganga Ram Hospital for treatment.
The hospital claimed it only offered fundamental infrastructure like a path lab and an operation theatre and that the surgeon was an independent consultant, relieving it of responsibility.
NCDRC verdict: Medical negligence case
After a detailed examination, the commission held that both the hospital and the doctor were guilty of medical negligence and dereliction of duty. The main findings are:
1. Failure to disclose proper risk and informed consent
The NCDRC emphasized that informed consent is not merely a formality – it is a patient's fundamental right. The commission observed:
The consent form did not specifically include mention of glue leakage as a possible risk.
The family and patient were not provided with sufficient time to reflect on the risks
This was a high-risk procedure, and it was even more necessary to have detailed and open communication regarding possible complications.
The information details provided do not have any mention of the risk of ‘leakage on the glue’ and the likely implications, the Commission said
2. Inadequate precautions were not taken.
The commission added that there should have been immediate action to re-establish blood flow after the glue oozed out and the artery was obstructed. Instead, the patient's condition worsened, resulting in amputation. The commission concluded that:
There was a poor response to the post-operative complications.
The hospital and the surgeon did not avoid permanent disability, even though they were aware of the risk.
The contention that the hospital was not responsible was unfounded since it was done on its premises.
In the light of these facts and statutory provisions, the “Bolam Test” can no longer be applied to a doctor's advice to his patient, unless it complies with the statutory provisions. The information given to the patient has to be examined from the patient's perspective. The information disclosed is not limited to risk-related inputs. It should include doctor's diagnosis of the patient's condition, the prognosis of that condition with and without medical treatment, the nature of proposed medical treatment and the risks associated with it, the alternative to the proposed medical treatment, advantages and risks of the said treatment and the proposed treatment. The doctor must ensure that information given is “in terms and at a pace that allows the patient to assimilate it, thereby enabling the patient to make informed decision, the commission said.
3. Compensation and fines
Given the severity of the negligence and its life-altering outcome for the young patient, the NCDRC held:
A compensation of Rs 75 lakh shall be received jointly by the doctor and the hospital within a month.
Interest of 12 percent per annum on the amount in case of delay.
Rs 50,000 for legal costs.
The commission also recognized the enormous physical, emotional, and financial burden on the patient, who now needs lifelong care and prosthetic replacement.
A landmark ruling for medical accountability
The NCDRC order strengthens the responsibility of individual doctors and hospitals alike to ensure that patients are given the care and transparency they are entitled to.
(Input from various sources)
(Rehash/Muhammad Faisal/MSM)