The National Consumer Disputes Redressal Commission (NCDRC) recently found a surgeon and a hospital accountable for the lack of consent regarding the removal, according to Medical News & Guidelines. In New Delhi, the National Consumer Disputes Redressal Commission (NCDRC) recently determined that a surgeon and a hospital were liable for failing to obtain consent for the removal of a 6cm sciatic nerve from a patient. Additionally, they did not record its removal in post-operative notes, inform the patient about it, or provide the necessary information. 

The Apex Consumer Court, holding them liable for deficiency in service, directed the surgeon and hospital to pay a lump sum compensation of Rs 5 lakh to the patient. Previously, the State Commission had also instructed them to reimburse the expenses incurred for treatment after the surgery. However, the top consumer court observed that the doctor and hospital justified the necessity of cutting the sciatic nerve to preserve the patient's well-being. 

The Apex Consumer Court, while acknowledging the defense of the necessity to sever the sciatic nerve, deemed the failure to obtain consent, record the procedure in post-operative notes, and provide information and guidance during discharge as negligence on the part of OP-1 and 2. The case originated in 2012 when the patient consulted Dr. Kokne, a surgeon at the treating hospital. Allegedly, Dr. Kokne recommended surgery to remove a tumor in the patient's thigh, assuring him of regaining proper mobility afterward. Consequently, the patient's wife consented to the surgery, which was performed by Dr. Kokne. During the procedure, the patient claimed that Dr. Kokne negligently severed the 6cm sciatic nerve, resulting in loss of sensation and mobility in his left leg, rendering him unable to walk unaided.

Additionally, it was alleged that Dr. Kokne failed to mention nerve severance in the post-operative notes. Two days after the surgery, Dr. Ravi, a pathologist, provided a test report revealing the patient's cancer diagnosis ("atypical lipoma favoring well-differentiated liposarcoma"). Subsequently, the patient underwent cancer treatment, including chemotherapy, at Gupte Cancer Clinic, incurring expenses amounting to Rs 3 lakh. The patient claimed that the clinic inaccurately reported improvement in sensation in his left leg. 

He also incurred expenses for chemotherapy. Later, after experiencing mobility issues, he sought medical advice and underwent another operation at the Meditrina Institute of Medical Science, Nagpur. The post-operative injury to the left sciatic nerve, resulting in a left foot drop, was diagnosed, leading to surgery to repair the severed nerve. This incurred expenses of Rs 3,75,000 for tests, medicines, and hospital fees, and Rs 4,25,000 for the operation. The complainant alleged negligence on the part of the treating surgeon and pathologist, as well as erroneous communication of the cancer diagnosis and subsequent treatment by the Cancer Clinic.

Legal notices were sent to the parties seeking Rs 18,30,000 in compensation after they refused to pay. The matter was then brought before the District Forum by the complainant, seeking compensation with interest and litigation costs. On the other hand, the doctors and hospital contested all allegations. They asserted that the surgeon, Dr. Kokne, was appointed by the hospital and that the tumor removal surgery was recommended after testing at a hospital in Nagpur, where it was advised that both the tumor and its surrounding area needed removal due to its cancerous nature. 

During the surgery, it was discovered that the tumor had spread to the surrounding area, necessitating its excision to prevent endangering the patient's life. The doctor claimed to have followed the principle of "life over limb" in medical jurisprudence and denied any medical negligence. They argued that the complainant did not adhere to post-operative instructions. The pathologist and the cancer clinic also refuted the allegations, stating that they performed their duties in accordance with the reports received.

They argued that the necessity of tumor removal due to its size and the entanglement of the left sciatic nerve with the tumor led to its natural severance during the operation. They denied negligence and asserted that they provided appropriate treatment. The District Commission dismissed the complaint, finding no negligence. However, the State Commission held that the operating surgeon should have obtained informed consent and noticed the injury to the sciatic nerve, directing the surgeon and hospital to pay compensation and reimburse treatment expenses. It ruled in favor of the pathologist and the cancer clinic.

The NCDRC observed discrepancies in the cancer diagnosis and subsequent surgeries, resulting in significant medical expenses for the complainant. The dispute revolves around informed consent, surgical care standards, diagnosis accuracy, and treatment appropriateness. The failure to inform the patient adequately is a critical issue. Patients should be given a reasonable amount of time to consider the information provided to them, allowing for a "cooling off" period during which they can reflect on the decision or seek advice. This ensures that patients do not feel pressured or rushed into making decisions.

On the day of surgery, patients may experience strain, mental stress, or the effects of pre-procedure drugs, which can impair their decision-making abilities. It is imperative that the doctor performing any procedure obtain the patient's consent directly; no one else can consent on behalf of a competent adult. The consent process should be properly documented and preferably witnessed, as legally acceptable consent is crucial.

Therefore, OP-1 and 2 bear liability to this extent. Modifying the State Commission's order, the Apex Commission directs the petitioners (OP-1 and 2) to jointly and severally pay a lump sum of Rs. 5,00,000 to the complainant for deficiency in service. This includes failure to obtain consent for the removal of the 6 cm sciatic nerve, failure to document its removal in post-operation notes, failure to notify the Complainant thereafter, and failure to provide necessary counseling as part of discharge notes, resulting in mental agony, harassment, loss of income, and litigation costs. This amount is to be paid within one month from the date of this order. Any delay beyond this period will incur an additional interest rate of 12% per year.