The Telangana Human Rights Commission (THRC) Tuesday held the state government “vicariously liable for negligence” leading to the death of a woman in the Wanaparthy district following a tubectomy surgery conducted at a Government Community Health Centre as part of its family planning indemnity scheme in 2017.
Dr Justice Shameem Akther, Chairperson, THRC, recommended a compensation of Rs 8 lakh for the deceased woman’s family, and further recommended that the state government provide employment to her speech-impaired husband to safeguard the family from extreme hardship.
The case dates back to June 2017, when M Lalitha, a mother of two minors and resident of Revally village, underwent a ‘free tubectomy surgery’ at a government medical camp. A day later, she developed severe complications, including stomach swelling and acute pain. Despite being moved through several facilities, including to the District Area Hospital in Wanaparthy and the Osmania General Hospital in Hyderabad, she died on July 9, 2017.
According to her brother-in-law, the complainant, Lalitha was admitted for the surgery even without the consent of the family.
The medical report cited “Cardio Pulmonary Arrest Septic Peritonitis following Perforation of Ileum” as the cause of the death. While Dr A Srinivasulu, District Medical and Health Officer, Wanaparthy, who performed the surgery, argued that the death was an unpredictable “physiological response” beyond medical control, the Commission rejected his defence.
Dr Srinivasulu submitted that he has been acquitted in the criminal case registered in connection with the woman’s death.
‘Defeats the very purpose of community health centres’
The Commission found that ileal perforation during surgery and delay in detection caused septic peritonitis and cardio-pulmonary arrest, rejecting the claim of mere physiological and post-surgical complications.
Justice Shameem Akther referred to ‘Modi’s Medical Jurisprudence and Toxicology and Ratanlal & Dhirajlal’s Medical Jurisprudence and Toxicology,’ that ‘Septic peritonitis following perforation of the ileum’ is not a spontaneous bodily reaction, but a condition that arises due to infection or injury, during or after surgery.
Such complications, the Commission observed, are directly linked to factors like negligent surgical procedure, failure to detect bowel injury etc, which are entirely within the control of the doctor who conducts surgery.
Justice Akther remarked, “Medical jurisprudence does not accept preventable infections or surgical injuries as mere physiological responses of the patient’s body”. Further, the Commission observed that when a patient develops septic peritonitis leading to cardio-pulmonary arrest after a routine procedure like tubectomy, “it indicates failure to promptly recognise and manage a surgically induced complication… which is an essential duty expected from the surgeon conducting the operation.”
The Commission also considered a report of the Superintendent of Police, Wanaparthy, which took legal opinion on the death from Assistant Forensic Professor, Osmania General Hospital, who said “there was a delay in detecting ileal perforation, thereby leading to septic peritonitis.”
Ileal perforation is a serious medical emergency in which a hole forms in the ileum (the last part of the small intestine), allowing intestinal contents to leak into the abdomen and leading to peritonitis, severe pain, and infection.
In view of the lapses, the Commission held the state government, being the employer of the surgeon who performed the surgery and other medical staff at the community health centre, “vicariously liable for the negligence on the part of the surgeon and other medical staff”.
The Commission maintained that in the present case, the surgeon and other medical staff failed to adhere to the requisite surgical and post-operative care protocols, particularly in promptly detecting and managing ileal perforation during and after tubectomy surgery. “Failure to maintain such basic standards of surgical care and post-operative care defeats the very purpose of community health centres and exposes patients to avoidable and life-threatening risks.”
Inadequate compensation
Considering the loss of the primary caregiver and the husband’s inability to earn a living effectively, and observing that the earlier payment of Rs 2 lakh was wholly inadequate, especially in view of the two minor children, the Commission exercised its powers under Section 18 of the Protection of Human Rights Act, 1993.
The final recommendations comprised an additional compensation of Rs 8 lakh to be paid to the husband and two minor children, in addition to the Rs 2 lakh already disbursed. And provision of employment for the husband, at least on an outsourcing basis, to support the minor children.
The Commission called upon the Telangana chief secretary to comply with these recommendations and forward a report on the action taken within one month.
The case dates back to June 2017, when M Lalitha, a mother of two minors and resident of Revally village, underwent a ‘free tubectomy surgery’ at a government medical camp 
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