DIMPY KHANNA Vs. A. S. SOIN

JUDGEMENT

(1.) Primary liver cancer is the third most common cause of cancer-related deaths worldwide. Despite careful selection for liver transplantation (LT) of patients with hepatocellular carcinoma (HCC), HCC may still recur after LT and is frequently associated with dismal outcome[Annals of Hepatology, Volume 27, Issue 1, January'February 2022, 100654].

(2.) Mr. Ravi Khanna (since deceased, hereinafter referred to as the 'patient'), a non-smoker and non-alcoholic person, who was suffering from off and on fever, weakness, loss of weight and appetite, approached Dr. M. Chhabra. After triphasic CT Scan of abdomen and other investigations it was diagnosed as multifocal hepato cellular carcinoma (liver cancer). Therefore, for further treatment, on 5/4/2012, consulted Dr. A. S. Soin (OP-1) at Medanta, the Medicity (OP-3). He confirmed the liver cancer and advised immediate liver transplant. Patient was informed about the standard liver transplant package for Rs.23,50,000.00 + additional applicable expenses. It was alleged that, the OP-1 assured that after liver transplant patient would be able to lead normal life without any complications. Accordingly, patient was told to arrange liver donor. As commercial donor was not available, therefore, his daughter-in-law Dimpy Khanna (Complainant-1) agreed to donate her liver. The OP-1 issued certificate on 1/5/2012 and subsequently, NOC was obtained on 2/5/2012 from Punjab State Authorization Committee under the Transplantation of Human Organs Act, 1994. The approval was subject to Surgeons being doubly sure that no metastasis of HCC are present in the patient's body at the time of transplant surgery. The patient underwent liver transplant successfully on 4/5/2012 and discharged on 22/5/2012 with follow-up advice. The patient visited OPs on 17/8/2012, underwent blood test, which revealed high AFP value i.e. 4780 as compared to 2120 seen in the report dtd. 5/4/2012. Thus, it was clearly indicative of presence of cancer cells in the body. After four months in the month of September, 2012 patient's condition deteriorated. For second opinion he consulted Dr. Manmohan Singh, who advised MRI Dorso Lumbar Spine. The MRI revealed cancer cells spread in the spinal cord of the patient. It came surprise and complete shock to the patient and his attendants, because the OP-1 misled the Complainants that after transplant surgery all cancer cells had been successfully removed from the body. Thus, it was alleged negligence of the OP-1 who never removed the cancer cells, but it spread to spine and subsequently the patient died on 2/4/2013. The Complainant incurred heavy expenses in crores for the treatment, thus being aggrieved, the Complainants ' Smt. Dimpy Khanna (daughter-in-law) and two sons of the deceased filed the Consumer Complaint and prayed compensation of Rs.5.00 Crores from the OPs jointly and severally along with litigation cost of Rs.55,000.00.

(3.) The OPs filed their reply and denied any negligence. They have treated the patient with highest standard of medical care at OP-3. On 7/4/2012, whole body PET ' Triphasic CT Scan was performed and confirmed diagnosis of liver cirrhosis with portal hypertension and Multifocal Hepato Celluar Carcinoma (HCC) and multiple metabolic indeterminate nodules in the lung. From the report underlying metastasis in lungs could not be ruled out. The 99m Tc-MDP Bone Scan was conducted on previous day ruled out the definitive evidence of skeletal metastases. Since the whole body PET- Triphasic CT Scan revealed the possibility of Lung Metastasis, on 11/4/2012, a biopsy was conducted from left lingual and lower lobe which revealed, "No evidence of malignancy and the specimen is suggestive of usual interstitial pneumonia". In order to mislead the Commission, the Complainant in the pleadings has suppressed the material fact that the OP conducted a whole body PET-Triphasic CT Scan, 99m Tc-MDP Bone Scan and a biopsy. As there was no extra hepatic spread, the Patient was considered for Liver transplant. It was the Complainant's own case that the cancer re-occurred in the spine. OPs submitted that no medical treatment can prevent the recurrence of cancer cells and failure to prevent recurrence of cancer does not constitutes medical negligence, when there are no pre-emptive treatment proved to be effective in preventing such recurrence.