Colonoscopy without consent leads to emergency surgery: Court finds hospital relied on daughter's approval; Kerala woman gets Rs 1 lakh

A Kerala consumer commission has ordered a Thrissur hospital and one of its doctors to pay over Rs 1 lakh to a woman whose colonoscopy was performed without her consent in 2011, a procedure that ended in a bowel perforation and emergency surgery that nearly cost her her life.

The Thrissur District Consumer Disputes Redressal Commission passed its final order on 29 June 2026, more than 14 years after the complaint was first filed, holding Mother Hospital and its gastroenterologist guilty of deficiency in service and medical negligence.

Colonoscopy Without Informed Consent


The complainant, a resident of Peringottukara in Thrissur, had visited Mother Hospital in February 2011 with two months of abdominal discomfort and loose stools. Her blood and stool reports came back largely normal, with one stool sample showing a positive occult blood result. On that basis, the treating doctor advised a colonoscopy to rule out any major colonic disease.

On 9 March 2011, she was admitted for the procedure. What the hospital did not do was obtain her consent for it.

Instead, consent was taken from her daughter. The complainant herself, a competent adult with full decision-making capacity, was never asked to sign.

The commission found this to be a clear and indefensible violation. It noted that the colonoscopy was not an emergency. It was a planned, elective procedure following outpatient consultations and investigation reviews. There was adequate time and opportunity for the hospital to sit with the patient, explain the procedure, its risks, and alternatives, and obtain her signature.

The commission pointed to a detail it found particularly telling. After the colonoscopy caused a perforation and emergency surgery became necessary, the operating surgeon obtained the complainant's own written consent for the laparotomy, with her son and daughter as witnesses. She was in pain, her abdomen was distended, and she was in a far more distressed condition at that point than she had been before the colonoscopy. Yet the hospital considered her capable of consenting then.

The commission stated the contradiction plainly: if the complainant was considered competent to understand, deliberate upon, and consent to a major surgical procedure under those more adverse circumstances, there is no logical basis for not obtaining her consent at the earlier stage when the planned colonoscopy was performed.

The commission relied on the Supreme Court's landmark ruling in Samira Kohli versus Dr. Prabha Manchanda, which established that patient consent is not a formality. A doctor cannot perform a procedure without informed consent except in genuine emergencies or where the patient demonstrably lacks decision-making capacity. Neither condition applied here.

Mother Hospital Thrissur and Vicarious Liability

The commission also held Mother Hospital's management directly liable, not just the treating doctor.

It applied the Supreme Court's ruling in Maharaja Agrasen Hospital versus Master Rishabh Sharma, which established that a hospital is vicariously liable for any negligence or deficiency committed by a doctor it employs. The hospital had a duty to ensure that valid informed consent was obtained in every case where it was required. It failed to do so.

The hospital had argued that a medical expert panel report commissioned by the District Medical Officer had found no negligence. The commission rejected this outright, pointing to a Kerala High Court order already on record that had found the panel's report worthy of being ignored entirely. The High Court had noted that the eight-doctor board reached its conclusion based solely on the statements of the accused doctors, which was not what an independent expert panel was expected to do.

What Went Wrong During the Colonoscopy

Beyond the consent failure, the commission found the conduct of the procedure itself to be deeply problematic.

The hospital records did not mention what time the colonoscopy started or ended. There was no documentation of whether carbon dioxide or air was pumped into the intestine during the procedure, which is standard practice. The two doctors involved gave contradictory explanations for why the procedure was abandoned midway. One said it was due to a tight angulation at the recto-sigmoid area. The other said it was because the patient was complaining of abdominal discomfort and distension. The commission noted that the discrepancy between the two accounts undermined the credibility of the procedure notes entirely.

The procedure notes themselves were described by the commission as cryptic. A notation stating there was tight angulation and the scope could not be traversed beyond it was, in the commission's words, a conclusion and not a sufficient description of the underlying anatomical or pathological finding. Proper documentation should have included the nature of the angulation, whether repeated attempts were made to negotiate it, whether the patient showed signs of distress, the stage at which perforation was suspected, and the specific circumstances in which the procedure was stopped. None of this was recorded.

The commission noted a further failure in pre-procedure assessment. The doctor had not adequately taken the patient's surgical history. The hospital later alleged in its written arguments that the complainant had a previous pelvic surgery which was not disclosed, and that this could have created adhesions making the colonoscopy more dangerous. The commission rejected this as a defence. It pointed out that a reasonably careful doctor performing a colonoscopy on an elderly woman would routinely ask about and document prior abdominal or pelvic surgeries. The hospital records showed no such question was asked and no such answer was recorded. The commission held that the absence of this documentation meant the doctor had not conducted an informed risk assessment before proceeding.

Patient Rights and Post-Procedure Care

The commission also found a serious failure in post-procedure monitoring.

After the colonoscopy was abandoned, the complainant was not discharged. She was taken to an observation room. By 8.45 PM that evening her abdominal distension had worsened significantly. Her blood pressure had risen to 160 by 100 millimetres of mercury by 9.30 PM. The perforation was only confirmed the following morning at 8.30 AM. During that entire period, from the end of the procedure through to the next morning, the doctor who had performed the colonoscopy did not visit or examine her once.

The commission called this a serious omission reflecting a lack of appropriate post-procedure care and monitoring.

The commission drew on a line of Supreme Court judgments to set out the standard it was applying. It cited Indian Medical Association versus V.P. Shantha, which brought medical services within the ambit of the Consumer Protection Act, Jacob Mathew versus State of Punjab on the requirement of reasonable care, and Kusum Sharma versus Batra Hospital on the standard expected of a reasonably competent practitioner. It then stated its conclusion clearly: a colonoscopic perforation alone does not establish negligence, but in this case negligence was established from a cumulative failure in consent, risk assessment, documentation, and post-procedure care.

What the Commission Ordered

The commission directed Mother Hospital, its medical superintendent, and the treating gastroenterologist to jointly and severally pay the complainant the following, all carrying interest at 9 per cent per annum from the date of filing the complaint until realisation.

A refund of Rs 28,790, covering the full amount paid for both the colonoscopy and the emergency laparotomy that became necessary only because of the perforation caused during the colonoscopy. Compensation of Rs 50,000 for the physical pain, mental agony, emotional distress, and hardship suffered as a direct consequence of the negligence. Litigation costs of Rs 25,000, significantly higher than the Rs 2,500 originally claimed, which the commission awarded on its own discretion given that the case had remained pending for over 14 years.

The two other doctors named in the complaint, who had played supporting roles during the procedure and the subsequent surgery, were exonerated. The commission found no evidence of negligence attributable to either of them.

All payments are to be made within 30 days of receipt of the order.

Check the case judgement here: