Case Study No. 4: Accidental Ischaemic Ureteric injury during Laparoscopic Hysterectomy is Not Negligence but adverse event
Disclaimer: The author Dr Savio Pereira has not signed any confidentiality agreement with the Complainant Patient, and is sharing information available from the Public domain and from his own knowledge. The information is for "pro bono" -for Public good. The Name of the Parties is not mentioned by the Author in his writings. There is no breach in confidentiality
Medical Subject Topics: Gynaecology, Laparoscopic Surgery, Urology, Adverse outcome Vs Medical Negligence
In 2014, A Complaint was filed in Shivamogga Consumuer Forum by a Complainant regarding Ureteric injury which developed after Laparoscopic Hysterectomy 11 days after Surgery.
I appeared for one of the doctors. The Defence taken that Adverse Outcome (detected appropriately) does not amount to Medical Negligence/Deficiency of Service.
The patient had not proven Medical negligence by PEER REVIEW GROUP OF DOCTORS, and hence the issue about DEFICIENCY IN SERVICE does not arise.
It is settled principle of law in Martin F D’Souza V Mohd. Ishfaq case [AIR 2009 SC 2049], that Consumer Courts are to seek opinion of Committee of doctors (i.e. Karnataka Medical Council/Medical Council of India), as a prima facie case of Medical negligence or an Expert Witness has to depose in the Consumer Court.
The Complainant underwent an Ultrasound Pelvis in an outside scan centre, and was diagnosed to have FIBROID UTERUS prior to 04/10/YYYY. The complainant consulted the doctor on 02/10/YYYY for irregular and heavy menstrual cycles and with the Ultrasound diagnosis of FIBROID UTERUS.
Hence, a clinical diagnosis of FIBROID UTERUS was made; and the patient was given the option of removal of UTERUS by the surgical procedure known as HYSTERECTOMY. The Complainant was thereafter admitted in Hospital on 04/10/YYYY. The Complainant was informed in detail of the Risks, Benefits and Alternatives verbally and also in the Form of a Written Informed Consent.The patient was given the options of open Surgery OR Laparoscopic surgery for removal of UTERUS. The patient opted for Laparoscopic surgery as a well-informed choice.
The patient underwent Laparoscopic hysterectomy and Bilateral salpingo oophorectomy under epidural anaesthesia, whereby the UTERUS and BOTH OVARIES were removed.
The intra-operative findings of the patient was Extensive bilateral endometriosis involving the tubes and ovaries with Fibroid uterus.
The doctors identified both the ureters during the procedure, and clear peristalsis was noticed which is evidence that ureters were intact at time of end of Surgery. Clear URINE was drained from the bladder from the indwelling catheter placed in the bladder for three days.
The known incidence of adverse outcome/complication of Ureteric injury is 0.5 – 2.5 % in laparoscopic hysterectomies. The Late Ureteric Injury (due to Ischaemia) in the instant case was due to ADVERSE OUTCOME and NOT NEGLIGENCE.
The patient had developed late ureteric injury due to thermal (heat) injury which manifests around 10 to 12 days post-operatively. The occurrence of a known adverse outcome/complication cannot be considered as Deficiency of service.
Urine leak was identified early on the 11th postoperative, and referred to an urologist for further management in Shivamogga.
Abel Medico-legal Consultants are Associates based in Bengaluru, Karnataka, India. The Associates include Lawyers, Medical Experts and other Subject matter experts.
We are a Composite Group of Lawyers, doctors and Subject Matter Experts who can handle your various Legal requirements in the Healthcare Industry. The Legal requirements of Healthcare industry involves Labour issues, Professional Misconduct issues, Consumer disputes, Civil disputes and Criminal disputes.
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Advocate D Dominic James (M.Com, L.L.B.)
Dr. Savio Pereira
(M.B.B.S., M.S. (General Surgery), M Med. Famiy Medicine, M.Sc. Healthcare Informatics, M. Phil (Hospital and Health Systems Management), MBA (Hospital Management), L.L.B.
Dr Savio Pereira is an experienced and Expert Medico-legal Consultant with Trans-disciplinary knowledge of Medicine, Law and Management. His interests are Consumer Law, Medical Negligence and Medico-legal matters.
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