Monday, October 14, 2013

The consumer protection Act provides a remedy against doctors who turn into butchers for money. 

Jayapal Reddy's wife, Kusuma, was a patient of gynaecologist Dr Padmini Valluri since 2006 when she delivered her first child. In 2009, she consulted Dr Valluri for menstrual problems. She was diagnosed with fibroid uterus and endometriosis, for which medications were given. On July 2010, during a follow-up, after an ultrasound examination, she was admitted to Yashoda Group of Hospitals in Secunderabad. Jayapal later learnt that Dr Valluri had operated on Kusuma and performed a total abdominal hysterectomy and bilateral salpingo-opherectomy with adhesiolysis.

Jayapal said claimed the operation was done without a valid consent from his wife or him. He said that due to abdominal pain, fear, and a disturbed state of mind, Kusuma could not give an informed consent and that the hospital had taken his signatures on a blank form. He said the hospital did not pay heed to his request to provide information related to the operation theatre documents and a case-sheet copy. Jayapal also claimed that he was not informed about the hysterectomy even after the surgery. He said the doctor had removed the fallopian tubes and ovaries unnecessarily, despite availability of alternative methods. 

Jayapal wanted another child, which would have been possible through IVF or the test-tube method with the help of a surrogate mother. But now, with his wife's ovaries and reproductive organs removed, it was not possible. Jayapal approached the state as well as the National Human Rights Commission, the Medical Council of India, and secretary of the heath and family welfare department of the government of India. He also filed a consumer complaint before the national commission. The commission served notices to the doctor and the hospital. However, they ignored the notices and the complaint was decided ex parte after the commission heard Jayapal, who argued the case himself.

The panel observed that there were gross discrepancies in the sonography report, the operation theatre findings, and the surgical pathology report. As per the sonography report, the anterior wall fibroid was 87x62 mm, but the operation notes mention it as a bulky uterus with multiple fibroids of size 25x15 cm, while the surgical histopathology report does not mention the presence of any fibroid.It questioned why both the ovaries were removed when the right one was normal with only a single fibroid, as per the sonography report. There was no explanation why an alternative line of conservative treatment was not adopted. The commission referred to various medical text books on the adverse effects of hysterectomy combined with removal of ovaries in patients below 40 years of age. It held that Kusuma's case was a deliberate misadventure, making her dependant on lifelong hormonal therapy. 

The commission elaborately dealt with the concept of consent. "It is not an event of obtaining signatures on paper before a patient submits to a particular treatment, but it is a process of communication. It is a proactive process of making sufficient disclosure, empowering the patient to consciously decide on what he or she considers best after understanding the pros and cons involved. Every adult of sound mind has a right to determine what shall be done with her/his body, and a surgeon who performs an operation without the patient's consent commits an assault for which s/he is liable in damages. This holds good except in medical emergencies, where a patient is unconscious and it is necessary to operate without delay. 

The commission observed that studies conducted in India had revealed that a significant percentage of illiterate and lower-income group women had been referred to private hospitals by registered medical practitioners, who received kickbacks for the referrals. These women were made to undergo hysterectomies without their consents. In its November 12, 2009 edition, TOI reported about women in Chennai, some only 25 years old, being made to undergo hysterectomies to raise insurance claims. On July 31, 2010, TOI reported about how a group of 20-year-old girls from Kannaram village in Andhra Pradesh were being made to undergo hysterectomies for abdominal pain. Another newspaper had reported on August 27, 2012, that over 16,000 hysterectomies in Bihar, most unnecessary, had been done at private hospitals during the previous year to avail insurance benefits under the National Health Insurance Scheme—Rashtriya Swasthya Bima Yojna (RSBY). Under the scheme, a family below the poverty line is entitled to Rs 30,000 for hospitalization.

The commission also observed that private nursing homes used RSBY to cheat women and conduct unnecessary hysterectomies for petty monetary gains. Such surgeries can have disastrous effects, like osteoporosis and heart diseases, requiring women to undergo hormone replacement therapy that can cause depression. Castigating unscrupulous doctors for their "hippocratic oaths" and for removing the very essence of womanhood for monetary gains, the commission suggested that the ministry of health and family welfare and the Medical Council of India initiate stringent action against erring doctors to protect innocent women. It observed that ovaries and fallopian tubes are of distinct value to a female and removal of these would require separate specific consent. In its order on September 20, 2013, delivered by Dr S M Kantikar for the bench, along with Justice J M Malik, the commission indicted Dr Valluri and the hospital of medical negligence and directed them to pay Rs 10 lakh compensation with 9% interest from the date of operation. If the order is not complied within three months, it would carry an additional further interest of 9%.
Impact: A doctor who operates without proper consent commits an assault on the patient, for which he is liable to pay compensation.
(The author is a consumer activist and has won the government of India's national youth award for consumer protection.) 
Courtesy: TOI