Hyderabad patient suffers hole in intestine after routine polyp surgery, hospital fined Rs 7.16 lakh

Hyderabad: The District Consumer Disputes Redressal Commission in Hyderabad ruled against Ananya Gastroenterology Hospital and two doctors for medical negligence after a routine polyp removal surgery went wrong.

A 49-year-old businessman had to undergo two emergency corrective surgeries and live with a waste collection bag attached to his abdomen for three months because doctors accidentally created a hole in his intestine during the procedure.

The commission ordered the hospital and doctors to pay Rs 7,16,100 to cover his medical bills and compensate him for the pain and suffering he endured.

Patient develops a perforation after a colonoscopy procedure

G Shiva Rama Krishna, a businessman from Dammaiguda Village, consulted Dr Ananda Kumar, chairman and founder of Ananya Gastroenterology Hospital, on April 11, 2022, with gastric and digestion problems. After diagnostic tests, including Endo profile and RFT, doctors diagnosed him with a colonic polyp in the large intestine and recommended colonoscopy and polypectomy under general anaesthesia.

The complainant underwent polypectomy on May 19, 2022, at Ananya Hospital. Dr D Srinivasulu, a consultant gastroenterologist, conducted the surgery between 4 pm and 4:35 pm. The hospital discharged Krishna around 7 pm the same day, stating the surgery had succeeded.

“The complainant developed severe pain in the abdomen, vomiting and fever immediately after discharge from the hospital,” the complaint stated. Krishna rushed back to Ananya Hospital on May 20, 2022. After examination and investigation, doctors diagnosed caecal perforation and peritonitis.

Hospital refers the patient for emergency treatment

Dr Ananda Kumar referred Krishna to AIG Hospitals on May 20, 2022. The referral letter stated the patient needed higher centre care. Krishna got admitted to AIG Hospital around 9:50 pm on May 20, 2022, and doctors immediately shifted him to the ICCU.

Dr GV Rao and his team treated Krishna with antibiotics and painkillers. The medical team informed the patient and family members that a caecal perforation had formed in his large intestine due to a small hole during the procedure at Ananya Hospital. Doctors performed corrective surgery involving IC resection and ileostomy on May 21, 2022, at 10:45 am.

“The diseased section of the intestine was removed and rejoined, and a stoma bag was attached for waste collection,” the complaint noted. The operative findings mentioned purulent fluid in the abdomen, ascending colon perforation, with the ascending colon loaded with stool and unhealthy edges. AIG Hospital discharged Krishna on May 26, 2022, after six days with a stoma bag.

Patient undergoes multiple corrective surgeries

Krishna suffered from consequential infections and pain for three months. He underwent another surgery on August 31, 2022, at AIG Hospital to join the healed intestine ends and permanently remove the stoma bag. The hospital discharged him after six days following close monitoring due to his medical history of heart problems.

“Due to the negligence and deficiency of service on the part of the doctors while undergoing procedure at Ananya Hospital, the complainant had to undergo two corrective surgeries at AIG Hospital, causing him immense pain and suffering,” the complaint stated.

Krishna incurred Rs 4,40,000 for the first corrective surgery and Rs 2,66,100 for the second surgery at AIG Hospital. He issued a legal notice on April 2, 2024, calling upon Ananya Hospital and the doctors to defray expenses and provide compensation. The hospital and doctors remained non-responsive, prompting him to file the consumer complaint.

Hospital defends treatment standards

Ananya Hospital, Dr Ananda Kumar, and Dr. Srinivasulu filed a written version denying the allegations. They contended that doctors informed Krishna about the risks of complications, including pain, bleeding, and perforation associated with the procedure. The hospital submitted consent forms signed by the complainant and his daughter.

“Colon perforation is a known complication of polypectomy varying from 0.7 per cent to 0.9 per cent and the rates of perforation have increased to 4 to 7 per cent in endoscopic submucosal dissection,” the hospital’s submission stated. The hospital cited medical literature showing colon perforation ranges from 0.16 to 0.2 per cent in diagnostic colonoscopies and up to 5% in some endoscopic colonoscopic interventions, including polypectomy.

The hospital also submitted that Dr Ananda Kumar contributed Rs 90,000 and Dr Srinivasulu contributed Rs 50,000 toward Krishna's medical treatment at AIG Hospital. The hospital coordinated with AIG Hospital staff to reduce the medical bill, securing a discount of Rs 21,575.

Commission finds deficiency in service

The consumer commission examined whether the perforation was preventable and whether the doctors fell below the accepted standard of care. The commission noted that, except for pre-operative and post-operative anaesthesia records, the doctors failed to file any evidence regarding procedure notes and findings.

“There is nothing on record to show that the doctors have taken any precautionary preventive techniques to minimise the risk of colon perforation,” the commission observed. The judgment cited medical literature filed by the hospital itself, which emphasised prevention measures including ensuring bowel preparation, removing residual faeces and liquid from the entire colon, using carbon dioxide for insufflation, and positioning the lesion appropriately.

The operative findings at AIG Hospital mentioned that the ascending colon was loaded with stool with unhealthy edges, raising questions about bowel preparation. The commission found no evidence that doctors performed post-procedural imaging to rule out microperforation before discharging Krishna within three to four hours after the procedure.

“In the absence of any evidence on record showing that the doctors have taken the preventive measures to reduce the risk of colon perforation while conducting polypectomy procedure and discharging the patient within 3-4 hours after the procedure without clinically ensuring and ruling out the incidence of any perforation or any other post-polypectomy complications, it leads to the irresistible conclusion that the consequential complication of caecal perforation led to the subsequent two corrective surgeries,” the commission stated.

Commission orders compensation

The commission held Ananya Hospital, Dr Ananda Kumar, and Dr Srinivasulu jointly and severally liable for deficiency in service. The court dismissed the complaint against AIG Hospitals and Dr Nageshwar Reddy as Krishna made no specific allegations or sought any relief against them.

The commission directed the hospital and doctors to pay Rs 5,66,100 toward medical expenses for the two corrective surgeries, accounting for the Rs 1,40,000 already contributed. The court ordered an additional Rs 1,00,000 toward incidental expenses and compensation for mental agony and suffering, plus Rs 50,000 toward legal expenses.

The commission ordered compliance within 45 days from receipt of the order. The medical expense amount will carry 9 per cent interest per annum from the date of the order until actual payment if the hospital and doctors fail to comply within the specified period.