Court holds surgeon negligent for not following medical text and missing a sub-clinical occult fracture

August 10, 2023

There is no harm in revisiting the diagnosis, especially if patient persistently complains of not receiving any relief from the existing line of treatment. A stronger case must be made for such a diagnosis if medical science points to a possible and known complications of such conditions. 

Irrefutable Facts

The patient met with a road accident. He was referred to the hospital after receiving first aid at another hospital. X-ray was performed, the orthopaedic surgeon diagnosed fractured shaft of the right femur. The patient was operated after a week.

During follow up after a month, the patient complained of pain, but the orthopaedic surgeon did not find anything abnormal on performing a repeat X-ray.

The patient experienced difficulty in walking and hence, six months later he consulted another orthopaedic surgeon. This doctor diagnosed an undisplaced intracapsular fracture in neck of the femur.

The patient revisited the hospital where he was operated. Yet another X-ray was performed. It revealed displaced intracapsular fracture of neck of the femur and was advised osteosynthesis - a valgus osteotomy and fixation with angled blade plate.

The patient refused the procedure due to financial reasons and got himself operated at a charitable hospital.

He sued the hospital and orthopaedic surgeon, alleging that he suffered intracapsular fracture in neck of the femur during surgery performed by the doctor. He pointed out that this fracture was absent in pre-surgery X-ray but was visible within 24 hours in post-surgery X-ray – a fact that the doctor failed to notice.

Doctors’ Plea

The doctor simply denied that intracapsular fracture in neck of the femur had occurred during surgery.

Court’s Observations

National Consumer Commission rejected doctor’s defense. Reason for this rejection was quoted from medical science: 

Despite due care and caution, the process of forcible hammering causes earlier undisplaced fracture to become displaced. Highest level of suspicion must be maintained for the concomitant presence of an ipsilateral femoral neck fracture. Intra-operative or immediately, post-surgery manoeuvres and radiographs should be used to rule out concomitant femoral neck fractures, and if the femur is suspected / evident, then in one sitting both surgeries for fracture neck and the shaft of femur shall be performed”.

The court found that while the orthopaedic surgeon had evaluated the patient with a pre-operative X-ray, he had failed to take X-rays intra-operatively or immediately after the reduction of femoral shaft fracture leading to failure / delay in diagnosing the fracture of neck femur.

The doctor and hospital were held negligent and ordered to pay compensation to the patient. 

Prevention Is Better Than Cure

  1. Keep an open mind and maintain high index of suspicion especially if the complaint/s from patient persists. Take appropriate proactive steps, such as revisiting the diagnosis, rethink on the course of action, further investigations or re-investigations and taking corrective measures. Failure to do so compromises patients’ safety and is nothing but negligence.
  2. Courts do take into account the fact that certain complications / mistakes / incidents are unavoidable, or the possibility of their occurrence is very high. Similarly arriving at the correct diagnosis, and that too on time could be a Herculean task.

An error of judgment is acceptable and certainly not negligence. But the doctor must have acted in accordance with the medical science / practice, have been vigilant, and be prompt in taking decisions and corrective steps to minimize harm to the patient. This case illustrates the aforesaid general legal principles aptly.


Source : 15MLCD (j53) Shiv Kumar Sharma v/s St. Stephens’ Hospital & Ors.

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