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endometriosis. In fact, ultra-sound may disclose fibroids, chocolate
cyst or other abnormality which may indicate endometriosis, but
cannot by itself lead to a diagnosis of endometriosis. This is
evident from the evidence of CW1, RW1 and RW2 and recognized
text books. In fact respondent’s expert Dr. Sudha Salhan admits in
her cross examination that endometriosis can only be suspected but
not diagnosed by ultrasound and it can be confirmed only by
laparoscopy. Even according to respondent, endometriosis was
confirmed only by laparoscopy. [Books on "Gynaecology’ clearly
state : "The best means to diagnose endometriosis is by direct
visualization at laparoscopy or laparotomy, with histological
confirmation where uncertainty persists."] Therefore the claim of
respondent that she had discussed in detail about endometriosis and
the treatment on 9.5.1995 on the basis of her personal examination
and ultra-sound report appears to be doubtful.
(ii) The appellant was admitted only for diagnostic laparoscopy (and at
best for limited surgical treatment that could be made by
laproscopy). She was not admitted for hysterectomy or bilateral
salpingo-oopherectomy.
(iii) There was no consent by appellant for hysterectomy or bilateral
salpingo-oopherectomy. The words "Laparotomy may be needed"
in the consent form dated 10.5.1995 can only refer to therapeutic
procedures which are conservative in nature (as for example
removal of chocolate cyst and fulguration of endometric areas, as
stated by respondent herself as a choice of treatment), and not
radical surgery involving removal of important organs.
48. We find that the Commission has, without any legal basis,
concluded that "the informed choice has to be left to the operating
surgeon depending on his/her discretion, after assessing the damage to the
internal organs, but subject to his/her exercising care and caution". It also
erred in construing the words "such medical treatment as is considered
necessary for me for\005\005." in the consent form as including surgical
treatment by way of removal or uterus and ovaries. The Commission has
also observed : "whether the uterus should have been removed or not or
some other surgical procedure should have been followed are matters to
be left to the discretion of the performing surgeon, as long as the surgeon
does the work with adequate care and caution". This proceeds on the
erroneous assumption that where the surgeon has shown adequate care
and caution in performing the surgery, the consent of the patient for
removal of an organ is unnecessary. The Commission failed to notice that
the question was not about the correctness of the decision to remove the
uterus and ovaries, but the failure to obtain the consent for removal of
those important organs. There was a also faint attempt on the part of the
respondent’s counsel to contend that what were removed were not ’vital’
organs and having regard to the advanced age of the appellant, as
procreation was not possible, uterus and ovaries were virtually redundant
organs. The appellant’s counsel seriously disputes the position and
contends that procreation was possible even at the age of 44 years.
Suffice it to say that for a woman who has not married and not yet
reached menopause, the reproductive organs are certainly important
organs. There is also no dispute that removal of ovaries leads to abrupt
menopause causing hormonal imbalance and consequential adverse
effects.
Re : Question Nos.(iv) and (v) :
49. The case of the appellant is that she was not suffering from
endometriosis and therefore, there was no need to remove the uterus and
ovaries. In this behalf, she examined Dr. Puneet Bedi (Obstetrician and
Gynaecologist) who gave hormone therapy to appellant for about two
years prior to his examination in 2002. He stated that the best method to
endometriosis. In fact, ultra-sound may disclose fibroids, chocolate
cyst or other abnormality which may indicate endometriosis, but
cannot by itself lead to a diagnosis of endometriosis. This is
evident from the evidence of CW1, RW1 and RW2 and recognized
text books. In fact respondent’s expert Dr. Sudha Salhan admits in
her cross examination that endometriosis can only be suspected but
not diagnosed by ultrasound and it can be confirmed only by
laparoscopy. Even according to respondent, endometriosis was
confirmed only by laparoscopy. [Books on "Gynaecology’ clearly
state : "The best means to diagnose endometriosis is by direct
visualization at laparoscopy or laparotomy, with histological
confirmation where uncertainty persists."] Therefore the claim of
respondent that she had discussed in detail about endometriosis and
the treatment on 9.5.1995 on the basis of her personal examination
and ultra-sound report appears to be doubtful.
(ii) The appellant was admitted only for diagnostic laparoscopy (and at
best for limited surgical treatment that could be made by
laproscopy). She was not admitted for hysterectomy or bilateral
salpingo-oopherectomy.
(iii) There was no consent by appellant for hysterectomy or bilateral
salpingo-oopherectomy. The words "Laparotomy may be needed"
in the consent form dated 10.5.1995 can only refer to therapeutic
procedures which are conservative in nature (as for example
removal of chocolate cyst and fulguration of endometric areas, as
stated by respondent herself as a choice of treatment), and not
radical surgery involving removal of important organs.
48. We find that the Commission has, without any legal basis,
concluded that "the informed choice has to be left to the operating
surgeon depending on his/her discretion, after assessing the damage to the
internal organs, but subject to his/her exercising care and caution". It also
erred in construing the words "such medical treatment as is considered
necessary for me for\005\005." in the consent form as including surgical
treatment by way of removal or uterus and ovaries. The Commission has
also observed : "whether the uterus should have been removed or not or
some other surgical procedure should have been followed are matters to
be left to the discretion of the performing surgeon, as long as the surgeon
does the work with adequate care and caution". This proceeds on the
erroneous assumption that where the surgeon has shown adequate care
and caution in performing the surgery, the consent of the patient for
removal of an organ is unnecessary. The Commission failed to notice that
the question was not about the correctness of the decision to remove the
uterus and ovaries, but the failure to obtain the consent for removal of
those important organs. There was a also faint attempt on the part of the
respondent’s counsel to contend that what were removed were not ’vital’
organs and having regard to the advanced age of the appellant, as
procreation was not possible, uterus and ovaries were virtually redundant
organs. The appellant’s counsel seriously disputes the position and
contends that procreation was possible even at the age of 44 years.
Suffice it to say that for a woman who has not married and not yet
reached menopause, the reproductive organs are certainly important
organs. There is also no dispute that removal of ovaries leads to abrupt
menopause causing hormonal imbalance and consequential adverse
effects.
Re : Question Nos.(iv) and (v) :
49. The case of the appellant is that she was not suffering from
endometriosis and therefore, there was no need to remove the uterus and
ovaries. In this behalf, she examined Dr. Puneet Bedi (Obstetrician and
Gynaecologist) who gave hormone therapy to appellant for about two
years prior to his examination in 2002. He stated that the best method to
