Principal surgeon performs surgery, patient dies. Assisting surgeon also held negligent!

June 29, 2023

A principal surgeon is the ship’s captain during surgery. Patient care, treatment, procedure, etc. is first and foremost the principal’s surgeon duty. Having said that, the assisting surgeon is also accountable. He is the XO – or an executive officer – of the ship.

While the principal surgeon is usually the one held liable for negligence, assisting surgeons are not exonerated from the legal liabilities towards the patient. The liability of each surgical team member is distinct as well as joint and depends on the facts and circumstances of each case. This case confirms this legal proposition.

Irrefutable Facts

A patient hospitalised with Acute Acalculous Cholecystitis (AAC) was initially managed conservatively by the principal surgeon. An open surgery was performed after three days by the principal surgeon, assisted by another surgeon. Unfortunately, the patient developed post-operative complications.

She developed breathing problems while being shifted out of the OT, and despite resuscitative measures, died within a few hours. The cause of death was “shock due to bacteremia and septicaemia.”

The lower court had held both doctors negligent. The order was challenged in National Consumer Disputes Redressal Commission.

Doctors’ Plea

The assisting surgeon stated in defense that he was merely assisted the principal surgeon during surgery. He was neither the owner nor an employee of the clinic where the surgery was performed.

The principal surgeon defended his decision to perform surgery. He stated that the patient was already in septicaemia; therefore, removing gallbladder was an absolute necessity to avoid fatal complications.

Court’s Observations

The top Consumer Court rejected both doctors’ appeals

While it was accepted that the role of surgeon was limited to assisting the principal surgeon during surgery, the court also observed that “as a surgeon he has duty towards the patient and decision making”, and hence he can’t be exonerated from the legal liability.

Citing USG reports, the Court observed that there was no stone in the gall bladder, and hence, the principal doctor’s initial step should have been conservative management instead of surgery. Both doctors should have performed investigations to rule out other causes of AAC, a crucial step that both missed. The court, therefore, held that the surgery was neither lifesaving nor an emergency - it was performed in haste.

Both doctors were held negligent.

Prevention Is Better Than Cure

1. This judgement has clarified the legal liability of surgeons of surgical team other than the principal surgeon. In a given case, other surgeons could also be held liable along with the principal surgeon. This legal dictum will apply to the team of anaesthetists also. This judgment has more legal weight as it is pronounced by the National Consumer Commission.

2. Elective surgery should always be a thoughtful decision taken by the surgeon for medically justified reasons. The reasons should be communicated to the patient / attendants and also documented in medical records. Any haste in performing an intervention could be viewed adversely by courts.


Source : 16MLCD (j1) Dr. Khurshid Ahmad v/s Surendra Prasad & Ors

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