Eye injury due to dengue fever, not delay by ophthalmologist: NCDRC relief to Delhi Hospital in medical negligence case

New Delhi: Reiterating the observations made by the Supreme Court, the National Consumer Disputes Redressal Commission (NCDRC) recently clarified that a simple lack of care, an error of judgment or an accident, is not proof of negligence by a medical professional.

As per the Apex Consumer Court presided by Justice Ram Surat Maurya and Mr. Bharatkumar Pandya negligence in the medical field is judged if an injury results from an act or omission.

It further held that there are three essential components of negligence- duty, breach, and resulting damage and in the medical profession, negligence necessarily calls for a treatment with a different.

These observations were made by the NCDRC bench while considering a complaint of medical negligence against Shri Balaji Action Medical Institute. As per the complainant, back in 2008, he was suffering from high-grade fever and was diagnosed with Dengue by the treating doctor at Shri Balaji hospital. He was admitted to the Intensive Care Unit, where various tests were conducted.

The test report showed "Dengue NS-1 Antigen" as negative. As per the complainant, due to negligent treatment in ICU, his 'Platelet Count' started falling and his visibility of the eyesight of both eyes became very low.

Allegedly, even though he informed the attending doctors and nurses about his low visibility on 05.10.2008 they ignored it. His condition became critical and the next morning the senior doctor advised for MRI. The report showed "Subcutaneous edema in the bilateral eyelids with pathological of wall of optic globes".

The complainant submitted that the doctors failed to control the infection in his eyes and the complainant lost visibility. Thereafter he was referred to AIIMS, New Delhi and the doctors informed the complainant's father that they were unable to diagnose the reason for loss of visibility.

Consequently, he was admitted to 'Dr. Rajendra Prasad Centre for Ophthalmic' of AIIMS, where he remained admitted for weeks but still did not get effective results. After getting discharged from AIIMS, the complainant took treatment at several other facilities but could not regain his visibility in any of the eyes. 

Therefore, the complainant alleged that due to gross negligence by the doctors of the treating hospital, the complainant became permanently blind. He further claimed that if the hospital was not competent to handle the complainant's patient, they should not have admitted him. Filing the consumer complaint, he prayed for a compensation of Rs 50 lacs for loss of eyesight, Rs 25 lacs for compensation for physical pain and mental agony and Rs 5 lacs as the medical expenses with interest @18% per annum from the date of loss of eyesight till the date of payment.

On the other hand, the hospital submitted that the patient was diagnosed with acute febrile illness with severe thrombocytopenia with bleeding diathesis, and bleeding gums. He also had purpuric spots on his legs. 

Immediately, he was admitted to the ICU and examined by Senior Consultant & Unit Head of the Hospital and gastrointestinal bleeding was suspected. The blood test report showed a platelet count nil. 

Considering the symptomatology and the reports of a dengue fever outbreak, 4 platelet concentrate and one unit of platelet apheresis were transfused to the patient. As there was bleeding from multiple sites, two units of FFP were also given along with IV fluids and other supportive therapy. His reports revealed severe life-threatening thrombocytopenia, haemoconcentration, mildly deranged prothrombin time, positive dengue serology suggestive of secondary or tertiary dengue infection. He had polyserositis (right pleural effusion), moderate ascites and gall bladder was edema. His clinical symptomatology and investigations were suggestive of dengue haemorrhage fever.

As per the hospital, the patient was looked after by a qualified ICU Resident Doctor and was constantly monitored and supervised by the treating consultants. 

Regarding the complaint of blurred vision, the hospital submitted that the patient was referred to a Senior Consultant Ophthalmologist, whose impression was intraorbital/cerebral haemorrhage and the patient was advised CT Scan of Head & Orbit axial + coronal cuts thin sections. CT scan report revealed focal hypo-densities left parietal region near the convexity and no evidence of intracranial haemorrhage. 

A neurologist was consulted and the case was reviewed by Senior Consultant Ophthalmologist also, who suspected impression of acute optic neuritis, vitereous haemorrhage due to haze, no view was possible in the fundus examination. He advised for MRI orbit, which revealed multiple micro-bleeds in the bilateral fronto parietal subcortical and periventricular white matter and basal ganglia.

There was a subcutaneous edema in the bilateral eyelids with pathological thickening of wall of optic globes. The patient was bleeding in vital organs like eyes. His platelets were maintained at more than 50000/min by platelet transfusion and his prothrombin time was maintained by giving this Fresh Frozen Plasma. The ophthalmologist team reviewed the patient and observed that the patient had epithelial edema+epithelial deficit over the cornea in both eyes. The eyes also had chemosis. As there was no improvement in the patient’s vision, he was referred to AIIMS for further management 

The hospital contended that the patient was treated according to standard protocol, with compassion, a humane touch and was given the best care. He was timely investigated and timely referred. Therefore, there was no medical negligence or deficiency in service on the hospital's part.

While considering the complaint, the State Commission sought an expert opinion from Maulana Azad Medical College, New Delhi, which formed a Medical Board. The Medical Board examined the papers and submitted its report dated 03.01.2014 stating that no medical negligence was committed at the hospital during the patient's treatment.

Meanwhile, the patient had also made a complaint against the hospital and the treating doctors before the Delhi Medical Council, who had conducted an inquiry after hearing the parties, the Council found that the treatment given to the patient in the hospital was per Standard Protocol and no negligence was committed.

However, the State Commission held that the patient had reported blurring vision while the Ophthalmologist attended to the patient. Therefore, there was no reason for not attending the patient by the ophthalmologist and starting treatment of the eyes. Even after examination by the Ophthalmologist, unreasonable delay was caused in obtaining the CT Scan report and MRI report and this was a crucial period for the patient. Therefore, holding that the hospital had committed negligence in taking care of the patient's eyes, resulting in permanent damage, the Commission had directed the hospital to pay Rs 35 lakh compensation for loss of eyesight and medical expenses to the complainant.

Challenging this order, the hospital approached the NCDRC bench. While considering the matter, the State Commission relied on the Supreme Court order in the case of Jacob Mathew v. State of Punjab, in which the Apex Court held that Negligence in the context of the medical profession necessarily calls for a treatment with a difference. To infer rashness or negligence on the part of a professional, in particular a doctor, additional considerations apply. A case of occupational negligence is different from one of professional negligence. A simple lack of care, an error of judgment or an accident, is not proof of negligence on the part of a medical professional. So long as a doctor follows a practice acceptable to the medical profession of that day, he cannot be held liable for negligence merely because a better alternative course or method of treatment was also available or simply because a more skilled doctor would not have chosen to follow or resort to that practice or procedure which the accused followed.

The NCDRC bench took note of the expert report by the Medical Board of Maulana Azad Medical College, New Delhi, which mentioned in its report that ophthalmologic complications like optic neuritis, which can lead to blindness are known to occur in dengue fever. Delhi Medical Council also in its order dated 27.04.2012 held that dengue along with superinfection subsequently leading to phthisis neuritis is a known complication of dengue.

"Medical literature shows that although spontaneous visual recovery is possible but optic neuropathy associated with dengue fever may result in severe permanent visual loss. State Commission has illegally ignored the MRI report, expert opinions and not considered the medical literature," noted the Apex Consumer Court.

"In the present case, the injury was caused to the patient due to dengue fever and not due to delay in attending by the ophthalmologist. Supreme Court in above cases held that negligence becomes actionable on account of injury resulting from the act or omission amounting to negligence attributable to the person sued. The essential components of negligence are three: “duty”, “breach” and “resulting damage”. Negligence in the context of the medical profession necessarily calls for a treatment with a difference. As such not only negligence but resultant damage due to negligence give rise for an action against the doctor/hospital," it further noted.

Therefore, holding that there was no medical negligence by the treating doctor, the NCDRC bench set aside the State Commission's order.

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-no-med-negligence-249172.pdf

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