Kiran Raj

The National Consumer Disputes Redressal Commission (NCDRC) has ordered a vascular surgeon and a medical facility to jointly pay Rs. 75 lakh as compensation in a medical negligence case that led to the amputation of a minor’s right leg. The bench comprising Presiding Member Subhash Chandra and Member AVM  J. Rajendra, AVSM VSM (Retd.) found that during an arteriovenous malformation (AVM) embolization procedure, an embolic agent inadvertently entered an unintended artery, causing complications that resulted in gangrene and necessitated amputation.

The complainants, Jaita Mitra Basu and Srimoyee Basu, filed the complaint under Section 21 of the Consumer Protection Act, 1986, against Dr. Anirban Chatterjee, a vascular surgeon, and Nightingale Diagnostic & Medicare Centre Pvt. Ltd. The case arose from medical complications suffered by Complainant No. 2, a minor, who had a progressively enlarging lump in the right gluteal region since birth. The condition was initially diagnosed as neurofibroma, and later, an FNAC test in September 2014 suggested a probable diagnosis of angiolipoma.

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On May 21, 2015, the complainants consulted a surgeon, who advised an MRI of the right pelvis. The MRI conducted the following day suggested the need for further evaluation. A subsequent CT angiography on June 15, 2015, confirmed the presence of arteriovenous malformation (AVM) in the right buttock. The complainants consulted Dr. Anirban Chatterjee, who reviewed the medical reports and recommended vascular embolization.

The embolization procedure was performed on September 16, 2015, at Nightingale Hospital, Kolkata. The complainants alleged that following the surgery, Dr. Chatterjee informed them that a "small amount of glue had accidentally slipped into the main artery of the right leg," but assured them that the issue was minor and would not adversely affect the patient. The doctor advised a minor follow-up procedure the next day, which was conducted on September 17, 2015.

On September 18, 2015, however, the patient’s condition deteriorated as blood circulation to the right leg stopped. Dr. Chatterjee recommended immediate transfer to Sir Ganga Ram Hospital, Delhi, where she was admitted on September 19, 2015. Upon examination, doctors found significant vascular deterioration, including "black discoloration, swelling, and loss of pulse." A CT angiography confirmed the severity of the condition, necessitating an "above-knee amputation of the right leg on September 22, 2015."

The complainants contended that alternative treatment options, including bypass surgery, were not considered and that the embolization procedure was conducted negligently, causing permanent disability. They sought Rs. 20.41 crore in damages, including medical expenses, emotional distress, loss of future prospects, and litigation costs.

Dr. Chatterjee contended that AVM embolization carries an inherent risk of "non-target embolization," wherein the embolic agent may inadvertently enter unintended blood vessels. He argued that the "high-risk consent form signed by the complainants acknowledged these risks" and that the procedure followed established medical protocols. He denied charging any professional fees for the surgery and asserted that the complainants did not qualify as consumers under the Consumer Protection Act.

The hospital (OP-2) contended that it merely provided infrastructure and nursing support and had no role in the medical decision-making process. It argued that the complaint was barred by limitation and suffered from non-joinder of necessary parties. The hospital further asserted that "Dr. Chatterjee was not a regular consultant" at the facility and that the complainants had chosen the hospital based on financial considerations.

The commission examined the evidence, including expert medical opinions, hospital records, and the AIIMS Medical Board report dated February 26, 2024. The AIIMS report stated, "The procedure undertaken for the treatment was justified. Endovascular glue embolization is the standard treatment of arteriovenous malformations." It also noted that "the concentration/proportion of glue used during the procedure can vary and the proportions used during the procedure were within the prescribed limits (both 1:2 and 2:1 can be used, depending on the DSA findings). This decision is best taken by the treating doctor based on the flow dynamics of the corresponding vessels."

The report acknowledged that "the complication encountered is described in the literature and can be encountered even if the procedure is done with due diligence." However, it further observed that "the risk of non-target embolization during these procedures has been documented multiple times in medical literature." The AIIMS report concluded that "it appears that the standard of care treatment was administered at all steps during the management."

The commission reviewed legal precedents governing medical negligence. Referring to Samira Kohli v. Dr. Prabha Manchanda & Anr. (2008) 1 CPJ 56 (SC), it noted that patients must be provided with sufficient information to make an informed decision regarding treatment. The commission observed that while the complainants had signed a high-risk consent form, "it did not specifically mention the possibility of glue leakage into unintended arteries."

The commission also referred to Jacob Mathew v. State of Punjab (2005) 6 SCC 1, wherein the Supreme Court held that a medical professional can be held liable if the standard of care falls below established medical norms. It noted that "the delay in recognizing the severity of the complication contributed to the eventual amputation."

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Based on the findings, the NCDRC concluded that Dr. Chatterjee and Nightingale Hospital were liable for medical negligence and deficiency in service. The commission directed that they jointly and severally compensate the complainants with Rs. 75 lakh, stating, "With due regard to the foregoing, we consider it appropriate to award a lumpsum compensation of Rs. 75 Lakhs to be paid jointly and severally by the OPs to the Complainants, within a period of one month from the date of this order." It further ruled that, "In the event of delay beyond one month, the OPs are also liable to pay simple interest @ 12% per annum on Rs. 75 Lakhs till the date of final payment."

The commission also awarded Rs. 50,000 towards litigation costs, directing the opposite parties to pay the amount to the complainants.

Advocates Representing the Parties

For the complainants:  Mr. Alok Saxena and Mr. Saksham T.

For the opposite parties:  Dr. Anirban Chatterjee (OP-1) appeared in person, along with Mr. Vikas Nautiyal and Mr. Srijan Nayak for OP-2.

Case Title: Jaita Mitra Basu & Anr. v. Dr. Anirban Chatterjee & Nightingale Diagnostic & Medicare Centre Pvt. Ltd.

Case Number: CC/2644/2017

Bench: Subhash Chandra (Presiding Member) & Member AVM  J. Rajendra, AVSM VSM (Retd.)

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