NCDRC holds Ludhiana hospital, doctors liable for trauma caused to woman by unnecessary face cancer surgery

The National Consumer Disputes Redressal Commission (NCDRC) has upheld a State consumer forum's decision to hold a Ludhiana-based hospital, its surgeon and pathologists at a Ludhiana medical college liable for medical negligence, over the performance of a radical facial cancer surgery on a woman without a confirmed diagnosis [Kanwalpreet Kaur v. Dayanand Medical College & Ors.].

The case concerned Dr. Kanwalpreet Kaur, a dentist by profession. In July 2014, Dr. Kaur (complainant) noticed a small lesion on her right cheek. She underwent an excision biopsy at Mediways Hospital, Ludhiana, during which a small tissue sample was removed for examination.

The biopsy specimen was sent to Dayanand Medical College (DMC) for histopathological analysis.

The pathology report issued by DMC on August 2, 2014, said the findings were “suggestive of malignant melanoma,” a serious type of skin cancer.

However, the report itself made it clear that further tests, including IHC markers, were needed before confirming the diagnosis.

Despite this, surgeons at Mediways Hospital proceeded to perform radical surgery on August 7, 2014.

The procedure involved wide excision of facial tissue and removal of lymph nodes in the neck, resulting in permanent disfigurement and complications for the patient.

The NCDRC agreed with the State Consumer Commission that the surgery was carried out on the basis of a tentative pathology report without waiting for mandatory confirmatory tests, such as immunohistochemistry (IHC) markers or a second pathological opinion, in violation of medical protocols.

Subsequent expert reviews, including an assessment by a medical board constituted at the All India Institute of Medical Sciences (AIIMS), did not find conclusive justification for the radical cancer surgery.

The NCDRC acknowledged that some facial surgery may have been required to remove the mole found Dr. Kaur's cheek, which ultimately turned out to be non-cancerous (spitz nevus).

However, in any case, the surgery conducted on her would not have been as drastic had the doctors waited for confirmatory reports on the extent of the suspect malignancy of the mole, the NCDRC observed.

"A wide excision was necessary even for the diagnosed Spitz Nevus. However, once again the extent and width as well as the depth of such an excision was dependent on a confirmatory report and therefore also if such confirmatory reports had been made available prior to the surgery, quite possibly the complainant may not have had to undergo the extent of the surgery that was performed," the ruling said in this regard.

The NCDRC further noted that Dr. Kaur had been left traumatised due to the surgery.

"The consequences of such a surgery have also impacted the complainant. The damage to the muscle, the nervous system and of course the facial looks of the complainant have definitely been grossly affected ... Her normalcy therefore is in a way substantially irretrievable ... She has therefore undergone the trauma of a subdued life due to the aberrations which is likely to continue subject to any treatment in future," it said.

The ruling was passed on multiple appeals filed against a 2018 Punjab State Consumer Commission ruling in the matter.

By the 2018 ruling, the State Commission had found the pathologists at DMC negligent for issuing a tentative diagnosis without confirmation. Further, it held Mediways Hospital and its surgeons responsible for performing irreversible surgery without certainty of malignancy.

The State Commission awarded ₹55 lakhs as compensation to be paid to Dr. Kaur, with 9 per cent interest. Of this amount, ₹45 lakhs was to be paid by the hospital and surgeons and ₹10 lakhs by DMC and its pathologists.

Dr. Kaur filed an appeal before the NCDRC for an enhancement of the compensation awarded to her in the matter. She contended that the haste with which the surgery was performed had left her with permanent trauma, and that she should be awarded at least ₹95 lakhs as compensation.

Dr. Kaur submitted that because of the unnecessary surgery, her nerves were damaged. The damage travelled to her upper lip, as a result of which she could not smile or laugh. The blinking of her right eye was affected. She also had to undergo corrective treatments at a hospital in the USA, adding to financial constraints. She argued that her professional career as a dentist has been affected as well.

The hospital and medical college concerned also filed appeals, questioning the State commission's findings against them.

On December 19, the NCDRC upheld the State Commission's findings of medical negligence, but found no reason to enhance the compensation payable.

The Commission found that Dr. Kaur appears to have consented to the hastily conducted surgery. Nevertheless, there was still partial medical negligence on the part of the pathologists of DMC and the surgeons of Mediways involved in conducting the surgery, it held.

However, it also noted that the involvement of one surgeon was limited to giving inputs for the surgery, and that there was no conclusive evidence to establish his participation in the surgery or hold him liable for it.

The NCDRC proceeded to refuse Dr. Kaur's plea to enhance the compensation amount, noting that she could not claim that she was unaware of the consequences of the drastic surgery.

All the same, considering the medical negligence involved in the case and the trauma undergone by her thereafter, the NCDRC enhanced the litigation costs payable to her from ₹55,000 to ₹5 lakhs.

The NCDRC also made it clear that the insurance companies impleaded as parties to this case are only liable to the extent specified in the insurance policies.

The complainant, Kanwalpreet Kaur, was represented by advocates Ujjwal Jain and Geetansh Bharti.

Dayanand Medical College was represented by Advocates BBS Sobti, Ritesh Khare and Namrata Chandorkar.

Mediways Hospital was represented by advocate KG Sharma.

United India Insurance Co. Ltd. was represented by advocates Abhishek Gola and Ravi Kumar.

Oriental Insurance Co. Ltd. was represented by advocate Mithilesh Sinha.