NCDRC dismisses PIL against urologist, Holy Family Hospital, says mode of treatment or skill differs from doctor to doctor

The case concerned a patient suffering from recurrent urinary tract infection (UTI), who visited the doctor at his private clinic and showed the urine Culture and Sensitivity (C/S) report in May 2002. The doctor prescribed Tab Bactrim for 7 days.

A couple of months later, the patient contacted the doctor once again for the same concern. This time the doctor advised surgery, and accordingly, the patient got admitted to the hospital on 8.8.2002. The pre-operative laboratory investigations like ultrasound, urine C/S, and Uroflowmetry and ECG were done.

Based on the report, the doctor suggested the patient to undergo a Cystoscopy and Urethral dilatation procedure in order to stop the recurring UTI and save the kidneys.

The very next day, the patient was operated by the doctor but in the evening she developed unexplained hypotension which was managed at the Holy Family Hospital, and on the 10th, the patient was shifted to EHIRC and treated for 7 days. On 12.08.2002, one of the doctors of EHIRC advised the patient to shift to Apollo Hospital but the advice was ignored by the complainant.

Soon after, the patient moved a complaint with the commission alleging that the treating surgeons have made intentionally wrong diagnoses of acute Ml. The complainant's counsel submitted that;

"It was the case of UTI due to virulent Esch. Coli organisms were the main cause of septicemia and later progressed to DIC and septic shock. The urologist ought to have treated the patient for UTI before the operative procedure."

He further argued that the hospital issued two discharge summaries showing contradictory clinical findings. The 1 discharge summary dated 10.08.2002 revealed at the time of discharge at the patient's condition was satisfactory, but the patient was in critical condition with life support when he was shifted in the ambulance to EHIRC.

Whereas the 2 discharge summary was nd issued on 12.08.2002 mentioned different findings. The hospital retained the 1 discharge st summary. Thus, the learned counsel reiterated that the hospital indicates that the treating surgeon was not monitoring the condition of the patient and he has not seen the patient at the time of discharge.

It was alleged that the 2end discharge summary was issued by the hospital to cover up their own negligence and create a false impression that the patient was in good condition while shifting to EHIRC.

Responding to the allegations, the advocate for the hospital argued that the complainant in his entire complaint has tried to set up a case of deficiency on the part of the hospital and the doctors but interestingly concealed about the treatment which the patient had received for the 7 days at Escorts. The hospital submitted;

"The Complainants made false, frivolous, and wrong allegations that the doctors have made intentionally wrong diagnoses of acute Ml. As a matter of fact, during her post-operative period in ICU, low BP and rising cardiac enzymes gave strong reason to suspect acute MI. It was with the consultation of Dr. S.S. Jolly, CMO of BHEL, it was decided to refer the patient to EHIRC for further management."

Deliberating the submissions of both the parties, the commission noted,

"The patient's medical history clearly revealed that she was suffering from various co-morbidities like breathing difficulty, hypothyroidism, and post tuberculosis inflammation of lungs. Such co-morbidities are fatal in this case, the court added. In our considered view there was no dereliction in the duty of care from the doctor. He is a qualified urologist and treated the patient as per the standard of practice. The DMC and MCI also did not find negligence from the hospital and treating doctors therein."

Referring to earlier cases examined by the Supreme Court, the Commission highlighted the order by the apex court in the Achutrao Haribhau Khodwa and others versus State of Maharashtra and others (1996) 2 SCC 634 as;

"The skill of medical practitioners differs from doctor to doctor. The very nature of the profession is such that there may be more than one course of treatment which may be advisable for treating a patient. Courts would indeed be slow in attributing negligence on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution. A medical opinion may differ with regard to the course of action to be taken by a doctor treating a patient, but as long as a doctor acts in a manner which is acceptable to the medical profession, and the Court finds that he has attended on the patient with due care skill and diligence and if the patient still does not survive or suffers a permanent ailment, it would be difficult to hold the doctor to be guilty of negligence."

As far as the matter of double summery is concerned, the court observed that 1st discharge summary was prepared on 09.08.2002 soon after the procedure at about 11:30 st anticipating that the patient would be in a fit condition to be sent home on the next day morning i.e. 10.08.2002, but due to her condition, she was transferred to EHIRC. Therefore at the time of shifting the patient to EHIRC another discharge summary was prepared on 10.08.2002.

Subsequently, the court dismissed the plea while stressing that the doctor is not liable for negligence if he performs his duty with reasonableness and with due care and the mode of treatment/ skill differs from doctor to doctor. The court held;

"In the instant case, we do not find any negligence during treatment of the patient, thus blaming the doctor and hospital is not correct. From the entire evidence on record (including inter alia the DMC, MCI decisions), it does not appear that the hospital did not perform his duties to the best of his expertise. The Complainant has failed to conclusively establish deficiency/negligence on the part of the treating doctor / the hospital."

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https://medicaldialogues.in/pdf_upload/pdf_upload-134584.pdf