Doctors cannot solely rely on Radiology Report, Must see film Also: WB Regulatory Commission

 Radiologist, Emergency Physician held at fault for missing foreign particle in X-ray

West Bengal: The West Bengal Clinical Establishment Regulatory Commission recently held a radiologist and an emergency physician liable for missing a foreign particle visible in the X-ray and devoiding a patient of the appropriate treatment. The commission also made sharp remarks towards the emergency physician, stating that he solely relied on the radiology report and never himself looked at the X-ray to form his independent opinion

The case is that of a patient who fell on broken glass and suffered deep cut injuries on his right palm with profuse bleeding, the complainant immediately rushed to OHIO Hospital. At the emergency, he was attended and treated by Dr Victor Saha (Treating Emergency Physician), who immediately injected 3 medicines and then referred him to the radiology department for X-ray of his right wrist.

Then the X-ray was done by Dr Nandini Thakur Jha, the radiologist and she told that everything was normal. He with the X-ray report and the X-ray plate went back to the emergency. Dr Victor Saha saw the X-ray report and told him that there was no fracture and there was no glass particles found on the site of the injury and noted down the same in the prescription. Dr Victor Saha then dressed his wounds and prescribing a few medicine, discharged him. He was asked to come back to the emergency in case of any further complication.

The patient continued to feel pain in his arm, despite all medications and after a few weeks, he went to Patharghata Primary Health Centre and they detected the presence of foreign body in his right palm from the X-ray plate and after surgical incision, the foreign body was removed.

The patient approached the commission complaining that due to the negligence in treatment and deficiency in service he has suffered not only pain and mental agony but also had to endure severe pain on his palm and was unable to attend his normal pursuits till the foreign body was removed.

During the hearing, the commission questioned the radiologist Dr. Nandini Thakur Jha with the X-ray plate and the report in question. She did not dispute that the said X-ray was done by her and the report was of her and she gave the report after considering the X-ray plate in question. She, however, admitted that X-ray plate showed the presence of a foreign body inside the palm of the complainant and on the face of the X-ray plate which is very much identifiable. However, she contended as the requisition was only for X-ray of right wrist along with fingers in stretch position, AP and Lateral, she made no further study and unfortunately, missed the foreign body and could not provide any observation about its presence

Dr Saha, the emergency specialist, on the other hand, stated that while referring him for X-ray did not specifically asked the radiologist to ascertain whether any foreign particle remain inserted inside the wounds. He then contended that even if such requisition is not noted in his prescription, still the radiologist is supposed to give her impression about the presence of a foreign body at the site, which is evident from the X-ray plate. He, however, could not explain how he also missed the same.

The Members having medical background independently examined the X-ray plate and according to them, the presence of the foreign body is very much evident.

After going through the submissions, the commission held both Saha, the Treating Emergency Physician and the Radiologist, Dr. Nandini Thakur Jha are in fault. None of them cannot deny their independent responsibility. When a patient comes to a doctor with bleeding injuries, with a complaint that such injury was sustained by falling on a broken glass, he should not only made requisition for X-ray of site for ascertaining whether there was any fracture or not at the same time in the backdrop of the case history he ought to have included his requisition the query whether any foreign body remain inserted or not.

Holding the emergency physician responsible the commission stated

After X-ray when the plate with the report was shown to the treating doctor and he missed the presence of foreign particle at the injury site and noted in his prescription "no bony abnormalities" the only logical conclusion would be that he went by the report and never himself looked at the X-ray report to form his independent opinion. He, therefore, certainly deviated from his duty which is bestowed on a medical practitioner when he is acting in his professional capacity.

Similarly, the commission held the radiologist negligent

Similar is the position with the radiologist, Dr. Nandini Thakur Jha. Merely because there was no requisition by the doctor, who referred the patient as to whether there was any foreign particle remain inserted at the injury site and requisition was for ascertaining whether there was any fracture or not, still no radiologist is absolved of his/her  duty to report about the presence of foreign particles when that reflects that from the X-ray plate itself. A radiologist, according to the medical protocol, is also bound to interact with the patient on the point how the injury was sustained.

The commission held that both the doctors, Dr. Victor Saha and Dr. Nandini Thakur Jha are liable for deficiency in patient care service.  As doctors are in regular employment of the OHIO and in its pay role, OHIO was also held responsible. The commission ordered the parties to pay a compensation of Rs 25,000 to the patient.

Attached is the judgement below