Failure to refer a patient to Higher Centre: Ophthalmologist slapped Rs 4 lakh compensation

The National Consumer Disputes Redressal Commission (NCDRC) recently upheld the decision of the state commission, imposing a compensation of Rs 4 lakh on a medical practitioner in a case of deficiency in service and negligence that led to loss of vision of a patient. The commission observed that  doctor did a procedure that was contraindicated and failed to send the patient to the higher centre or any retina specialist for further management.

Case details :

Dr. Ashok Pachori, Agra V/s. R.K .Tripathi Appeal No.83/2008 & 295/2008. Decided on 03/01/2018

Before : Hon. Dr. S.M. Kantikar, Presiding member.

Facts in Short :

1. In the month of October-1999, the Complainant Mr. R.K. Tripathi, A Sub-Inspector, suffered brutal right eye injury due to a bamboo stick and his eye lens got dislocated. The Opponent Doctor Mr. Pachori operated on the right eye, however even after removal of bandage the patient had persistent pains.

2. Prior to the injury, in the month of Jan-1999, after getting eyes checking done in another Hospital, the Compliant was told that his right eye lens is dislocated and it requires removal and insertion of new lens. Finally he approached Dr. Ashok Pachori who assured the patient that if the immediate surgery is done, his right will be alright and the new lens will be replaced. On 21/12/1999 the operation was done, but the pains were persistent even after 4-5 days.

3. During follow-up also the patient complained of pains and no vision, but the Doctor assured that he has removed the dislocated lens and everything will be alright. Finally, the patient went to another Doctor in Allahabad, where he was told that without removing the injured lens, the Opponent Doctor implanted new lens and therefore implantation of IOL was not at appropriate place & further there was retinal detachment also. Finally patient went to Chennai at Sankara Netralaya and got himself operated.

4. Thus, he filed a case of Negligence in UP Consumer Forum against Dr. Ashok Pachori on the ground that he implanted ACIOL without removing the injured lens and it resulted into retinal detachment and he lost his vision.

5. The Doctor denied all the charges of negligence and submitted that he examined the complainant and found that there was a posterior sub luxation of lens in the right eye due to blunt trauma. The lens was dislocated laterally and inferiority, also there was vitreous herniating in anterior chamber. Hence, he had planned for Intra Capsular Cataract Extraction (ICCE) on 21-12-1999 with A.C. Intra Occular Lens (IOL). The Doctor further submitted that he has tried to remove overlying vitreous with cellulose spunge, but it was not possible. Also anterior vitrectomy was done removing it by doing all these lens dipped into vitreous, as Zonules were very weak. However, papillary area was clear. He has performed to remove vitreous from anterior chamber and to ensure clear and better vision ACIOL was implanted. The same was informed to the complainant and was asked to come for regular follow up, but complainant never came after 22-12-1999 for follow up treatment or checkup.

6. The State Commission allowed the complaint and ordered the Doctor to pay Rs.4 lakhs.

7. However, the Doctor approached the National Commission for suspension of order and the Complainant approached for enhancement of compensation.

NCDRC Decision :

1. The National Commission after perusing the medical record and hearing the arguments, observed that all the Doctors whom the patient approached advised him to remove the lens and further treatment to be taken by implantation of IOL.

2. It was observed that the Doctor made conscious efforts to take out the lens from vitreous but it was failed. The Doctor had tried to extract the lens by means of cryoprop, but it was not freezing the upper pole of lens but overlying vitreous starting freezing. However, despite all these procedures the lens dipped into vitreous as zonules were very weak. Therefore, the Doctor performed anterior vitrectomy and removed the vitreous from anterior chamber and, thereafter, ACIOL was implanted.

3. It was lastly observed that as per medical literature without extraction of subluxated lens the IOL implantation is contraindicated. The Doctor would have sent the patient to the higher center or any retina specialist for further management but he failed to refer the patient. Therefore, the Doctor was held to be deficient in his services and negligent. However the Commission rejected the petition of Complainant filed for enhancement of compensation.

4. The case in hand goes back to almost 20 years back. Now the treatment techniques must have changed tremendously. Nevertheless the message is clear, In case of doubt refer the patient to higher center. The Diagnosis Practice is now changing. Doctors do not solely rely on clinical diagnosis.

We can only say - कालाय तस्मै नमः

Good news is that, the Commission previously also has held that referring a patient to Higher Center is not Negligence while dismissming the complaint (R.P. No.2862/2013, Rudresh V/s. Dr. Srinivas V. & ors., on 02/09/2015) of Medical Negligence against Drs. On relying upon the celebrated judgment of Hon. Supreme Court in Jacob Mathew Vs. State of Punjab & Anr., (2005) 6 SCC 1 wherein it has been observed by the Hon’ble Supreme Court

“a professional may be held liable on one of two findings : either he was not possessed of requisite skill which he professed to have possessed, or, he did not exercise with reasonable competence in given case, the skill which he did possess.”

Thanks and Regards,

Adv. Rohit Erande

Pune. ©

You may the judgment on following link

http://cms.nic.in/ncdrcusersWeb/GetJudgement.do?method=GetJudgement&caseidin=0/0/FA/295/2008&dtofhearing=2018-01-03