'Fit to fly' advice after Retinal Detachment Surgery results in permanent damage to eye: Consumer Court relies on expert opinion, exonerates Ophthalmologist

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) has exonerated a Kolkata-based hospital and eye surgeon from charges of medical negligence while providing treatment to a patient who was suffering from Rhegmatogenous Retinal Detachment.

Although the patient claimed that the doctor wrongly advised him 'fit to fly' after the surgery, resulting in permanent damage to his eye, the NCDRC bench dismissed the complaint after referring to the expert opinion given by AIIMS medical board. 

The patient in this case, a senior Scientist at Lawrence Livermore National Laboratory, underwent cataract surgeries back in 2004 and 2006. However, he had to undergo laser treatment back in 2007-08 when he developed retinal tears in his right eye. Later, back in February 2012, he suffered 'Rhegmatogenous Retinal Detachment' causing blurring of vision in left eye with dark peripheral vision.

Therefore, he approached Dr. Sourav Sinha, the treating doctor, who advised the patient to undergo surgery for retinal detachment. After the surgery, the doctor injected a Perflouropropane (C3F8) gas bubble in the left eye to press the retina tightly against the eye wall.

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The complainant alleged that the doctor gave the prescription as 'fit to fly' after about 2 weeks of the surgery, despite being aware of the complications to travel by Air. When the complainant boarded the flight for US San Francisco, he suffered severe pain in his left eye and was unable to see from left eye and the pain further became unbearable.

After landing in San Francisco, the patient rushed to another doctor's clinic, where the patient was examined and various tests were conducted. On 30.03.2012, recurrent temporal Rhegmatogenous retinal detachment was seen because the gas bubble was reabsorbed to less than 2%. The treating doctor in San Francisco informed the complainant that because of travelling by air, the patient suffered optic nerve injury and it caused permanent damage to his left eye. Due to flight journey, there was expansion of the gas bubble leading to increased intraocular pressure (IOP) and caused central retinal artery occlusion. The visual activity in the left eye was reduced to fingers counting from two feet. Following this, the doctor performed 'Scleral Buckling' procedure.

Therefore, the complainant alleged that due to gross negligence, he had developed glaucoma in the left eye. Consequently, the complainant tried to settle the matter with Dr. Sinha, issued legal notice to the doctor and demanded $ 100,000 as compensation. Since the treating doctor did not agree, the complainant filed the Consumer Complaint before the NCDRC bench and prayed for Rs 8,46,79,000 as compensation.

On the other hand, the doctor and the hospital denied any negligence. They also pointed out that there was no allegation of any medical negligence with respect to the treatment and the Vitrectomy operation of the left eye. Referring to the advise 'fit to fly', the treating doctor submitted that he had advised the patient to see a retina specialist after 10 days and it was mentioned 'fit to fly' in the prescription. Therefore, it clearly implied that it was only after the patient got examined by a Retina Specialist.

However, the complainant made his travel plans to San-Francisco without consulting the Retina Specialist, alleged the treating doctor. He also alleged that the complainant did not produce any evidence to prove that he had booked his flight for US after issuance of prescription.

After considering the arguments by both the sides, the Apex consumer court sought expert opinion from AIIMS Medical Board. The board of experts from AIIMS mentioned in its report, 

1. The surgeon was aware of restriction of air travel in presence of a gas bubble in the eye is evident from an email provided by the complainant dated 30/10/2014 which clearly mentions that he was declined permission to fly to Kathmandu on 16/02/2012.

2. The subsequent development of chronic glaucoma from the event is unlikely because the patient had well controlled IOP for a long period after the event. However, the patient has a propensity for glaucoma as has been seen in the other eye.

The top consumer court also perused the letter of of Dr. Scott S. Lee to Dr. Todd Severin and noted, "it reveals that nearly after 2 years 8 months of the laser surgery, on 08.01.2015 Dr. Scott examined the Complainant, and found the corrected visual acuity 20/20 in both eyes. It was the perfect vision of a normal eye. In our view the Complainant deliberately suppressed the report of routine check-up dated done on 08.01.2015 by Dr. Scott S. Lee."

Further perusing the relevant medical literature, the NCDRC bench observed that the doctor allegedly admitted the act of providing wrong prescription via email and agreed to pay compensation. Subsequently, the complainant served a legal notice to the doctor and the hospital. However, at this outset, the NCDRC bench noted,

"In our view mere writing letters or emails do not extend the limitation / cause of action. Thus in the instant case, it was not the continuous cause of action. Moreover, the Complainant's prayer for compensation appears to be imaginary and unjustified."

Therefore, the bench opined that there was not evidence to prove allegations of negligence. In this regard, the bench also referred to Supreme Court order in the case of Jacob Mathews V State of Punjab and S. K. Jhunjhunwala vs. Dhanwanti Kaur and the recent judgment in the case of Dr. (Mrs.) Chanda Rani Akhouri & Ors. Vs Dr. MA Methusethupathi & Ors. Referring to these judgments, the NCDRC bench reiterated that a medical practitioner cannot be held liable simply because things went wrong from mischance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference to another.

Dismissing the complaint, the Apex consumer court mentioned in the order,

"Based on the entirety, putting the reliance on the AIIMS expert medical board's report, the medical record and the literature on the subject, the Complainant failed to prove his case. It is not feasible to conclusively attribute non-adherence to duty of care and standard of practice from the treating doctor and the hospital."

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-no-medical-negligence-195174.pdf

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