CONSUMER DISPUTES REDRESSAL FORUM – X
GOVERNMENT OF N.C.T. OF DELHI
Udyog Sadan, C – 22 & 23, Institutional Area
(Behind Qutub Hotel)
New Delhi – 110 016
Case No.647/2005
Smt. Shahjahan Begum,
W/o Sh. Iqbal Hussain
R/o Mohalla Rasulpur,
P.O Suar,
Distt. Rampur (UP). ………. Complainant
Vs.
- Dr. Harsh Bhargava,
Sr. Consultant Orthopeadic & Spinal surgeon
Indraprastha Apollo Hospital
Sarita Vihar, Delhi Mathura Road
New Delhi-110044.
Also at:
32, Todarmal Road
Bengali Market
New Delhi-110001.
- Indraprastha Apollo Hospital
Through its Managing Director/
Chief Medical Officer
Sarita Vihar, Delhi Mathura Road
New Delhi-110044 …………..Respondents
Date of Order: 11.08.2016
O R D E R
Ritu Garodia- Member
The Complaint pertains to medical negligence by OPs.
The complainant was suffering from a severe low back pain with radiation to lower limbs and associated numbness. It is stated that OP1 conducted laminectomy with one sided instrumentation (Pedicle screws,L4,L5,S1) on 19.09.2002. The patient
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developed right side neuralgia and one sacral screw was removed, 5 days after surgery. The complainant continued suffering burning sensation on both feet and severe neuralgia pain. Thereafter on 19.08.2003 she consulted doctors at Sir Ganga Ram Hospital. The complainant was admitted on 26.11.2003 in the aforementioned hospital and the screws fixed in the earlier surgery were removed.
The complainant alleges that there was no requirement for implantation of screws in the spine and as such it was done with a malfide intention. The complainant prays for refund of Rs.2,36,451/- as the expenses incurred in consecutive surgeries and Rs.10,00,000/- as a compensation. The complainant annexed discharge summary of Apollo Hospital dated 18.09.2002and Sir Ganga Ram Hospital dated 30.09.2003 along with receipt from the hospital.
OP is the respondent doctor who conducted the first surgery. OP1 stated that the complainant had severe lumber canal stenosis with severe symtoms of neurological claudication. The treatment was explained to husband of complainant in detail. The doctor conducted a neural compression by means of laminectomy. Fusion was achieved by bone grafting using pedicle screws and rod system. It is stated that it is a standard surgical procedure. Further more the use of implant renders stability to spine to make the patient mobile. The fusion between the unstable motion of spine is achieved by bone grafting. Implants are used until the fusion is complete after which they can be removed.
OP further stated that the complainant develops severe leg pain and hence, a second surgery was done to remove one of the screws. The other two screws were to be removed in due process of time. The OP1 also conducted a test of nerve studies i.e. NCB, ENG to ascertain the improvement in neuralgia. It is further stated that the implants had to be removed after achieving bone fusion.
OP2 is the treating hospital to conduct the first surgery. OP2 admits the complainant was a patient with backache radiating to thighs and both legs. The surgery was conducted on 19.9.2002 for lumber canal stenosis. It is stated that during surgery, lumber recalibration with laminectomy was done along with one side instrumentation. It
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is also admitted that the patient develops severe neuralgia right side for which one screw was removed in a surgery conducted on 23.9.2002. The consent was duly given by the patient. OP2 also stated that the complainant had concealed her past history regarding an earlier surgery. The screws were applied to give stability to the spine which is a standard surgical procedure. The failed back syndrome with implant SITU is a known diagnostic entity and by the passage of time fusion would have taken place and the implants could be removed. It is alleged that the complainant failed to follow up with the OP hospital. OP2 in their reply to legal notice dated 5.7.2004 has stated that the complainant had two problems.
- Compression of Spinal chord which was dealt with laminectomy.
- Instability causing back pain which was dealt by bone grafting and instrumentation.
OP3 is the insurance company providing indemnity to OP1 and OP2.
OP doctor in its affidavit stated that the treatment given at Sir Ganga Ram Hospital was simple bone grafting to stabilise her back bone. The complainant in her affidavit stated that she went to the treating doctor to follow-ups but her OPD cards are not filed on record as they are missing.
Both the parties have filed sworn affidavit in consonance with their pleadings. The back pain and the surgery dated 19.09.2002 is admitted by both the parties. The discharge summery of OP1 and OP2 states the diagnosis was lumber canal stenosis. The discharge summery further admits that limber recarliberation was done with laminectomy. The discharge summary of Op2 is reproduced as Patient Mrs. Shahjahan Begum presents as a case of lumber canal stenosis who was admitted on 18.09.2002 and posted for surgery on 19.09.2002. During surgery lumber recaliberation was done with laminectomy 1.3/L4/L5 and L5/S1. As there was a gross instability between L4/L5 and L5/S1 bony fusion with one sided instrumentation was done.
Post operatively patient has severe neuralgia right side for which x-rays revealed loosening of bone around S1 screw and there was a CSF leak. Patient was again taken for surgery on 23.09.2002.
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Finding revealed the S1 screws had become loose and was impinging at existing root on right. There was contusion around that root. The pressure was remained and dural repair was undertaken. Patient’s neuralgia persisted and was detained in the hospital. Patient is being discharged on following advice.
The only issue before us is whether the treating doctors were negligent in implanting screws as the standard procedure. The Wikipedia in en.m.wikipedia.org define spinal fusion as spondylodesis or spondylosyndesis, is a neurosurgical or orthopaedic surgical technique that joins two or more vertebrae. Surgeon use supplementary bone tissue-either from the patient (autograft) or a donor (allograft)-or artificial bone substitutes in conjunction with the body’s natural bone growth (osteoblastic) process to fuse two or more adjoining vertebrate.
Spinal fusion treats a variety of pathological conditions to eliminate abnormal motion of the vertebrate that causes pain, neurogical deficit, or spinal deformity. Common conditions incorporsting spinal fusion in their surgical treatment are spinal stenosis, spondylosisthesis, cervical discopathy, spinal fractures, scoliosis, and kyphosis.
There are two types of spinal fusion and the procedure is written as
- Posteroletral Fusion places the bone graft between the transverse process in the back of the spine. These vertebrae are then fixed in place with screws and/or wire through the pedicles of each vertebra attaching to a metal rod on each side of the vertebrae.
- Interbody fusion places the bone graft between the vertebra in the area usually occupied by the intervertebal disc.
In most cases, the fusion is augmented by a process called fixation, involving the placement of metallic screws (pedicle screws often made from titanium), rods, plates, or cages to stabilize the vertebrae and facilitate bone fusion.The fusion process typically
takes 6 to 12 months after surgery.During this time external bracing (orthotics) may be required.External factors such as smoking, osteoporosis, certain medications, and
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heavy activity can prolong or even prevent the fusion process.If fusion does not occur, patients may require reoperation.
The discharge summary of Sir Ganga Ram Hospital states that it is ‘failed back syndrome with implant in situ”. The wikipedia in en.m. wikipedia.org defines Failed back syndroms is a condition characterized by persistent pain following back surgeries.
Failed back syndrome (FBS), also called “failed back surgery syndrome” (FBSS), refers to chronic back and/or leg pain that occurs only after back (Spinal Surgery), usually after laminectomy . It is characterised as chronic pain syndrome. Multiple factors can contribute to the conset or development of FBS. Contributing factors include but are not limited to residual or recurrent spinal disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hypermablity with instability, scar tissue (fibrosis), depression, anxiety, sleeplessness and spinal muscular deconditioning. An individual may be predisposed to the development of FBS due to systemic disorder such as diabetes, autoimmune disease and peripheral blood vessels (vascular) disease.
It is clear from medical literature that implantations of screws/rods are standard procedure and fusion takes place between 6-8 months of surgery. One the fusion takes place, the medical professional can take a call to removed the screw/rods implanted in a patient. Here, the complaint did not follow up with OPs and got a re-evaluation done at Sir Ganga Ram Hospital. The later hospital removes the screw implying the fusion has taken place. The FBS has also been explained in medical literature along with contributory factors. Nowhere does the second hospital state that treatment by OPs were wrongly or negligently undertaken.
In the lights of facts disclosed that there was no negligence by treating doctors/hospital. Hence the complaint is dismissed. File be consigned to Record Room.
(D.R TAMTA) (RITU GARODIA) (A.S YADAV)
MEMBER MEMBER PRESIDENT
