Jyoti Devi vs Suket Hospital And Ors.

APPENDECTOMY is one of the most common surgical procedures performed. "This instant case describes a rare but significant post operative complication illustrates a foreign body - sharp needle in the abdominal wall. Rapid diagnosis with directed history, physical examination, and CT or X -ray of the abdomen may help for the correct and immediate management of such patients."

THE complainant, Jyoti Devi, underwent appendectomy operation on 28 -06 -2005 at OP No. 1 -Suket Hospital, Sundernagar, Himachal Pradesh. It was performed by OP No. 2 -Dr. Anil Chauhan. She was discharged on 30 -06 -2005, further examined on 07 -07 -2005. Thereafter, on 26 -07 -2005 she went to OP No. 1 with complaint of pain at the site of surgery. Again on 30 -09 -2006 she was admitted at OP No. 1 and discharged on 02 -10 -2006 wherein she was treated conservatively for cellulites of abdominal wall, but the pain persisted continuously. Hence, she went to other hospital at Mandi where re -exploration for surgical wound was done and drain was placed for draining out the pus. According to the complainant the pain persisted up to year 2010 and finally she went to PGI, Chandigarh and took treatment from 29 -09 -2010 to 06 -10 -2010. At PGI, a foreign body was detected at the site of previous surgery. It was removed, which revealed about 2.5 cm straight needle. Therefore, alleging medical negligence the complainant filed a complaint before the District Forum, Mandi for claiming compensation to the tune of Rs. 19.80 lacs. The District Forum allowed the complaint and directed the OP 1 & 2 to pay jointly and severally Rs. 5,00,000/ - to the complainant. The OP 3 & 4 - insurance company is to indemnify the OP 1 & 2. The OP 1 & 2 preferred First Appeal No. 70/2014 before the State Commission, Himachal Pradesh at Shimla. The State Commission partly allowed the First Appeal and reduced the compensation from Rs. 5,00,000/ - to Rs. 1,00,000/ -. Hence, aggrieved by the order of the State Commission the complainant petitioner filed this revision petition.

WE have heard counsel for both the parties. The short 3 days delay in filing of this revision petition. The same is hereby condoned. The counsel for the petitioner submitted that after appendectomy operation the patient for two years visited the OP -1, hospital number of times, but the OPs failed to diagnose the cause of pus and pain at the surgical wound. The OP just treated for draining of the pus, thereafter the patient remained asymptomatic for 1 1/2 years. Thereafter, she was getting sharp pressing pain on forward bending. Therefore, the OP -2 was negligent during the initial appendectomy operation, which left behind the needle.

THE argument advanced by the learned counsel, Dr. P.N. Tiwari on behalf of OPs is that the patient suffered the symptoms of pain, after five years. It is impossible that the human body to retain any foreign substance or metallic needle for such a long time. He submitted that any foreign body will be rejected by the body within 36 to 48 hours. After appendectomy, the patient took treatment from several hospitals till 2010. He also submitted that, no needle was found during re -exploration surgery performed at Mandi in December, 2008 and the drain was inserted. He further submitted that for appendectomy operation the curved needles are used universally for stitching. Therefore, there was no role of straight needle. The complainant has not produced the entire medical record pertaining to her treatment at several hospitals. We have perused the medical record, the pleadings before lower fora submitted by both the parties. It is an admitted fact that in September, 2005 the complainant underwent appendectomy operation. Thereafter, she suffered repeated abdominal pain and pus discharge from the surgical wound. It may be due to unhygienic condition of the patient. The patient had no history of fever. The ultrasound performed on 29 -09 -2010 revealed a needle just beneath the interior abdominal wall in Right iliac Fossa. The x -ray also revealed presence of a needle like structure in right lower abdomen. The PGI, Chandigarh operated the patient and removed the foreign body.

THE most important question to decide in the instant case is, whether, a straight needle about 2.5 cm in length, can be retained for a long period, in the interior abdominal wall i.e. just medial to previous abdominal appendectomy scar? In this context, we took reference from various surgical books and came to know that, in very rare occasion foreign body or sharp object were found after a decade also. "• Sharp metallic bodies (needles) penetrate the abdominal wall usually accidentally. Incidence of their deliberate insertion is rare. Such foreign bodies usually produce a pricking sensation but surprisingly they may remain silent. Patient may present with unrelated symptoms and the discovery of the foreign body on radiological examination may come as a surprise.

• Generally, early postoperative masses are easier to diagnose and treat, while late postoperative abdominal wall masses could be of various etiologies that warrant the use of a wide spectrum of diagnostic modalities and consequently different treatment options. All these facts signify the importance of preoperative diagnosis. Thus, abdominal ultrasound, contrast -enhanced multi -slice CT and other diagnostic modalities should be used according to clinical findings."

WE are of considered view that, the OPs should have been careful during follow up treatment. It is apparent that, the post -operative care from the OPs was casual; it was not as per standards. It was the duty of the OPs to investigate the non -healing surgical wound. Hence, it was a deficiency in service, not a standard of practice. The learned counsel for the petitioner had placed reliance upon the judgment of this Commission in Smt. Vidya Devi v. Mrs.(Dr.) P.N. Mohanty & Anr., Original Petition No. 67 of 1999, decided on 04 -05 -2010, wherein it was held that a surgical mop was left in the body for more than two years. In this case, patient had continuous pain and pus discharge. The patient underwent further treatment from different hospitals, at one point of time. Therefore, it is difficult to fathom who had left behind the straight needle.

THEREFORE , OP cannot take a plea that; patient took treatment from few other hospitals which might have caused retention of needle in the abdominal wall. In this context, we apply the "Egg Skull Rule" in this case, wherein liability exists for damages stemming from aggravation of prior injuries or conditions. It holds an individual liable for all consequences resulting from their activities leading to an injury even if the victim suffers unusual damages due to a pre -existing vulnerability or medical condition.

WE cannot ignore the fact that the patient suffered physical agony for more than 5 years. Also, the case is dragged for more than a decade now. In our view, the compensation of Rs. 1,00,000/ - awarded by the State Commission is on lesser side, therefore, we award lump sum compensation of Rs. 2,00,000/ - (Two lacs) as just and proper. Accordingly, we modify the order of State Commission, the OP is directed to pay Rs. 2,00,000/ - to the complainant, within 2 months from the date of receipt of this order, otherwise, it will carry interest at 9% pa, till its realization. However, there shall be no order as to costs.