13 years after being suspended by MCI, Radiologist gets HC relief

New Delhi:Observing that baseless targeting of doctors is bound to prejudice public interest, the Delhi High Court bench on Monday set aside an order issued by the erstwhile Medical Council of India against a Radiologist. The Ethics Committee of MCI had directed back in 2010 to temporarily remove the name of the concerned radiologist from the Indian Medical Register for three months for alleged falsification of medical records.

However, the HC bench comprising Justice C. Hari Shankar took note of the fact that the Apex medical body could not find any medical negligence by the doctor and confirmed the allegation of falsification of records, which was never even raised against him.

Expressing its disappointment over the issue, the bench observed, "On reading the impugned order, I am constrained to observe that, having found that no allegation of medical negligence could sustain against the petitioner, the MCI confirmed, against him, the allegation of falsification of records, which was never even raised against him in the first place, merely so as to justify imposition of punishment on the petitioner. This is an extremely unhappy situation."

"Striking off, from the Indian Medical Register, of the name of a doctor, partakes of the character of a civil death, insofar as the professional career of the doctor is concerned. The familial and societal ramifications of such a decision, which is bound to garner publicity, are also far and wide reaching," it further noted.

The concerned Radiologist had challenged the MCI Ethics Committee order dated March 20, 2010, through which the Council had ordered removal of the petitioner doctor's name from the Indian Medical Register temporarily for a period of three months for falsifying records.

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Back in the year 2007, the patient had approached Dr Kothari, a gynaecologist at Krishna Medical Centre, New Delhi with a complaint of Amenorrhoea with intermittent vaginal bleeding since two months. An USG dated May 9, 2007 indicated threatened abortion with a large uterine haematoma. Although the patient was referred to Safdarjung Hospital for further management, she again approached KMC with excessive vaginal bleeding. Thereafter the patient was scheduled for, Dilation and Curettage.

The Radiologist, Dr. Batra was informed about the patient's condition and was further told that his ultrasonological services were urgently required. After reaching the hospital, the radiologist proceeded to conduct the ultrasonography of the patient and observed that her uterine cavity contained products of conception and blood clots. At the request of the treating gynaecologist, Dr. Batra also assisted in removal of the blood clots and POC. At the end, the patient underwent ultrasonological examination and after the Radiologist satisfied himself that no blood clots or POC remained in the uterine cavity of the patient, the patient left.

Unfortunately, the patient died later on the same day. The patient was taken to Safdarjung Hospital, where she was declared brought dead. The Post Mortem report at Safdarjung Hospital recorded the cause of death of the patient as “haemorrhagic shock, consequent upon perforation of the uterus, following surgical intervention”.

The family members alleged that she had died because of medical negligence during her treatment at KMC. Following this, the Police authorities at P.S Ambedkar Nagar sent a notice to the petitioner radiologist on May 28 and directed him to produce the record of medical treatment of the patient along with accompanying documents. Although the petitioner doctor did not have the records of KMC, he responded to the notice.

When the police authorities sought the opinion of the Delhi Medical Council (DMC) on the issue, the Council wrote to the petitioner on June 11 and attributed negligence to the treating doctors including the Radiologist. Therefore, the petitioner doctor was asked to submit his statement of defence with supporting documents to DMC. The petitioner doctor submitted his statement and informed that he had nothing to do with the treatment and management of the patient. He further alleged that he only provided ultrasonographic guidance to the treating doctor.

It was alleged by the Radiologist that Dr. Kothari, the treating Gynaecologist misrepresented to the DMC that the petitioner doctor had conducted USG twice, firstly at 3.30 pm and thereafter at 4 pm and had found the uterine cavity to be empty on both occasions. In his plea before the HC, the doctor averred that this could not have been possible as he received a call from KMC on his Cell phone number at 3.28 pm. In his plea, the Radiologist further alleged that the records produced by the Gynaecologist before the DMC were also fabricated to make it appear that the petitioner doctor had conducted two ultrasonographic examinations on the patient.

On December 5, 2007, the radiologist submitted another representation to DMC and reiterated his submissions. Further representations were submitted by him on 30 December 2007, 11 January 2008 and 16 January 2008.

In its order, DMC held Dr. Batra negligent and noted, "The failure of Dr. Pramod Batra to detect fluid/blood in the pelvic cavity after half an hour of the completion of D & C procedure in the ultrasound done at 4.00 pm reflects the lack of exercise of reasonable degree of skill, knowledge and care in monitoring the clinical condition of the patient."With this observation, DMC ordered removal of Dr Batra's name from the Delhi Medical Register for a period of three months.

Dr. Batra appealed before MCI against the DMC order and maintained his stand that he had conducted only one USG of the patient and that the records of KMC had been fabricated to suggest otherwise. The Ethics Committee of MCI reiterated the DMC order. However, the Executive Committee of MCI asked the Ethics Committee to reconsider the matter. Thereafter, the MCI Committee ordered to remove the name of Dr Batra from the Indian Medical Register for a period of three months for falsifying the records as observed by DMC.

Aggrieved by this, the doctor approached the HC bench and his counsel argued that the basis on which punishment has been imposed on the petitioner by the MCI is foreign to the case initially set up against him and which he was given an opportunity to defend. Pointing out that the initial allegation was of medical negligence, the doctor's counsel contended that MCI was required to exonerate the doctor.

On the other hand, the counsel for MCI submitted that the duty discharged by MCI in such cases is purely quasi-judicial in nature. He further submitted that the concluding findings of the MCI against the Radiologist is to be found in the concerned order itself. It was further claimed that Dr. Batra could not explain why in his noting on the official record of KMC, he was shown to have carried out USG on the patient twice, contrary to his assertion that he had carried out the USG only once and had not conducted USG after D&C was over.

While considering the matter, the HC bench observed, "In the impugned Order, the MCI has dropped the allegation, against the petitioner, of medical negligence. The petitioner has been mulcted with the punishment of removal of his name from the Indian Medical register on the ground of falsification of records."

"At no stage, prior to the passing of the impugned Order by the MCI, was the petitioner ever charged with falsification of records. Commencing from the initial communication dated 11 June 2007, received from the DMC, the allegation against the petitioner was medical negligence, which contributed to the unfortunate death of *** (patient)," the bench pointed out.

"The allegation of medical negligence has been categorically found, by the MCI, to be without substance. The petitioner never having been put to show cause regarding any other allegation, including the allegation of falsification of records, the sequitur to the finding that the petitioner was not guilty of medical negligence had, as Mr. Aggarwal correctly submits, necessarily to be his honourable exoneration," it further added.

With this observation, the HC bench set aside the HC order and addressing the allegations of falsification of records, the bench observed,

"To my mind, the question of whether the petitioner conducted USG of *** (patient) once, or twice, really does not arise, as the entire D&C procedure, carried out by Dr. Archana Kothari, was admittedly under the ultrasonographic guidance provided by the petitioner. Frankly, I fail to understand how, in such procedure, it can precisely be stated that the petitioner conducted USG of (patient) a finite number of times. (patient)was under ultrasonographic evaluation, by the petitioner, as part of the assistance provided in the D&C procedure carried out by Dr. Archana Kothari, throughout the process. That being so, it cannot be said that there was any falsification, by the petitioner, of the record of KMC."

"If one reads the impugned order, one finds no observation, or finding, to sustain the conclusion that the petitioner had falsified the hospital records. There is no reference to the precise record which the petitioner had allegedly falsified. Falsification of records is an extremely serious matter. It partakes of crime, and is coloured by criminal intent.. Where the falsification takes place in connection with treatment of a patient, especially where the patient is dead, the seriousness of the misdemeanour increases manifold. A finding of falsification of records cannot, in such circumstances, be lightly arrived at. The order must be precise and exact, regarding the record which was falsified, the manner in which it was falsified at the time when such falsification took place. Prior to arriving at such a finding, the concerned doctor has to be put on notice regarding all these aspects, so that he is in a position to respond. The impugned Order merely reiterates the finding of the DMC in this regard. The defence of the petitioner, including the reference to the phone call received by him at 3:28 p.m., have not even been extended the courtesy of a cursory glance," it further observed.

Pointing out that targeting doctors without any basis can prejudice public interest, the court noted,

"While it is true that a medical professional is expected to possess a certain minimum standard of competence, failing which he has no justification for dispensing medical treatment, and that conduct which fall short of even that minimum medical standard, or display callous negligence to the welfare of a patient, has to be dealt with severely, it is equally true that the scalpel cannot be wielded by a shaking hand. Baseless targeting of doctors, unmindful of the consequences, is bound, in the ultimate eventuate, to seriously prejudice public interest."

Setting aside the MCI Order dated 20 March 2010, the court observed,

"No more need be said on that count, in the present case, as the MCI has, quite fairly, discharged the petitioner of the charge of medical negligence. Having so held, the MCI could not proceed, nonetheless, to punish the petitioner, for falsification of records. Even if it were to be assumed that the charge of falsification of records could be confirmed by the MCI despite no such allegation having been made against the petitioner at any earlier point of time, such a charge, in order to sustain, has to be based on clear, cogent and comprehensible material, which has been put to the concerned Dr. and which the doctor that opportunity to rebut."

"The impugned Order fails to meet the necessary standard as would persuade this Court to sustain the finding, against the petitioner, of falsification of records or, consequently, the punishment that the MCI has deemed appropriate to award to the petitioner on that account," it added.

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/delhi-hc-order-213547.pdf

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