JAMES PHILIP Vs. H. UNNI KRISHNAN AND ORS.

JUDGEMENT

(1.) Facts:

(2.) THE complainant, Mr. James Phillip (hereinafter referred to as the patient), a bank employee, was suffering from backache. In September, 1999, he consulted one orthopedic surgeon, Dr. Lazer Chandy. Subsequently, in the next year (2000), the patient felt difficulty in climbing the stairs due to weakness in the legs and consulted Dr. Gigy Kuruthukulum, Neuro Physician. MRI study was done. It showed some growth in thoracic vertebrae (T10). Thereafter, he was referred to Dr. John Mathew, a Neuro Surgeon, who advised for removal of the tumor, which would cure the problems. On 15 -05 -2000, the patient approached OP -1, Dr. H. Unnikrishnan, a Neuro Surgeon, practicing at Lissie Hospital, Ernakulam (OP -2). Various laboratory tests including x -ray, ultrasound, etc., were done. The patient was operated on 20 -05 -2000. The OP -1 informed the patient that, tumor needed to be removed by surgery which would consume about two hours and two weeks, hospitalization needed and then he can resume to his official duty after six weeks. The patient was able to walk, used to drive his car prior to hospitalization. OP -1 examined the patient along with another Neuro Surgeon, Dr. Uttham Kumar. The OP -1 told that compared to brain tumor operation, his operation is a minor one. The complainant sought advice if there was any need to go to higher centre, but the OP -1 told that there was nothing to worry. On the day of operation, at 8 AM, the patient walked up to operation theatre. After operation, he was shifted to the ICU, where he noticed that he could not move his legs and thereafter he was unable to speak normally. His sound became husky and gruffly. He was kept in the ICU for 11 days; the OP -1 never visited regularly but, visited him first time on 7th day, just for 2 to 3 minutes. The OP -1 informed that, it is a temporary loss of sensation in his legs. The patient further submits that he had no control over the urine and bowel movements; hence a catheter was inserted to empty his bladder. Due to operation on the spine, his body position had to be changed every two hours which caused severe discomfort and he could not get proper sleep. The biopsy was reported as a malignant tumor, it was not disclosed to the complainant by the OP -1. During the course of the hospitalization, the OP noticed a tumor between heart and lungs for which FNAC through the chest, was decided, but the relatives of patient were suspicious about the movements of the hospital staff and OP -1. Therefore, decided to shift the patient to Chennai. The patient was flown to Chennai on 31 -05 -2000 and admitted in Rai Memorial Hospital & Cancer Research Centre at Chennai. Patient was given radiotherapy. After few days of the treatment, the CT Scan of chest revealed no signs of any tumor, hence FNAC was not performed. The patient took 14 sittings of radiation. In addition, he had also undergone three cycles of Chemotherapy. At Chennai, the doctors noticed that the operated wound was not healed, although, a fresh dressing was done, daily. There was continuous CSF leak from the operated wound. It was informed to the patient that OP -1, after removing the tumor from the T10 vertebra, had negligently damaged the spinal cord membranes. OP -1 opened the Dura unnecessarily and failed to close it properly, thereby putting the life of the patient to dire risk. There was no informed consent, the patient's wife had signed the consent form, it was only for the removal of tumor and not for any other procedures adopted by OP -1. It resulted into permanent disability for which OPs are responsible jointly and severally. The doctors at Chennai re -sutured the wound. It took about two months for complete healing. The complainant further submitted that he was completely bed ridden, lost the hope to regain sensation. With the hope of regaining sensation in the legs, the patient was taken to Christian Medical College (CMC, Vellore) on 24 -07 -2000, for intensive physiotherapy. The PMR Department at CMC told that, the patient had 100% loss of sensation and, therefore, shall not be able to walk again. Therefore, patient had been confined to wheelchair. At CMC, patient was given occupational therapy, physiotherapy and speech therapy, under supervision of Dr. Suranjan Bhattacharjee. During that period, he was administered three more cycles of Chemotherapy by Hematology Department. Thereafter, a fresh MRI scan of operated area was taken, which noticed that there was still a lesion near spinal cord area. Dr. Mammen Chandy of Neurology Department decided to do a needle biopsy, but it was deferred as the lesion was too close to spinal cord. The complainant submitted that Dr. Chandy opined that further surgery is not possible because the OP -1 committed a serious mistake by opening the Dura and damaging the spinal cord that had caused irreparable damage to the patient and expressed about 5% chance of recovery. The patient was shifted on 18 -12 -2000 to intensive rehabilitation program at Rehabilitation Institute, Bhagyam, which was about 5 km from CMC Hospital. During second week of January 2001, a swelling appeared in the operated area. Hence, he was again investigated and MRI scan was performed which detected, nothing abnormal. Even then, the wound was not healing properly, therefore, on 08 -03 -2001, while dressing the wound, the doctors noticed that a cotton thread was coming out from the wound from the operated area. Hence, the patient was shifted immediately to CMC Hospital, once again. The Neuro Surgeon, Dr. Shanker, removed the pieces of cotton gauge which was left behind by OP -1 through surgery on 20 -05 -2000. After removal of foreign body, the wound started healing immediately.

(3.) THE OPs filed written version. Submitted that the patient approached OP -1, Dr. Unnikrishnan, after obtaining a second opinion from Dr. John Mathew, a Neurosurgeon. The OP -1 performed laboratory investigations and MRI. As per MRI, there was destructive expansile growth at D -11 vertebra. The patient was obese and hypertensive also. Therefore, in view of the advance cancer, the OP informed the patient and his relatives that the operation can only, at best, be palliative and not curative. The inherent risk was explained and the surgery was performed after written informed consent. The patient was declared fit by the cardiologist. Hence, he was operated on 20 -05 -2000. The operation was successful, but during post -operative period, the patient developed paraparesis (weakness of lower limbs) and changes in the voice were due to advanced cancer. Therefore, it was no way concerned with the surgery. After laminectomy for Dural decompression, no dural pulsations were visible, therefore, OP -1 opened the Dura, it revealed arachnoiditis and Arterio -Venous Malformation (AVM). After treating for both, the spinal cord was swollen; therefore, purposely, the Dura was left open. There was wound dehiscence on 9 post -operative day and CSF leak was noted. Re -suturing was done under local anesthesia. The HPE report revealed about the possibility of Plasmacytoma and Non -Hodgkin's Lymphoma (NHL). Therefore, there was no negligence in the diagnosis and treatment, given to the patient.