Eyesight loss after premature delivery: Doctors, LLRM Medical College exonerated

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently exonerated Lala Lajpat Rai Memorial Medical College and two of its doctors in the Pediatrics Department from charges of medical negligence while treating a newborn baby, who lost her eyesight.

Although the complainants alleged that the doctors did not refer the child for Retinopathy or premature screening which ultimately resulted in her loss of eyesight, the top consumer court noted that proper advice was given in the Discharge Slip.

The matter concerned a new-born child, who was born prematurely. After her birth, the child had certain respiratory distress and thereafter she was shifted to Lala Lajpat Rai Memorial College Hospital, Meerut Uttar Pradesh. She was treated at the Neonatal unit of the Paediatric Department. However, her parents alleged that the treatment at the LLR Memorial College was negligent and as a result of it, she ultimately lost her eyesight.

The main allegations of negligence were mainly against the HoD Dr. Upadhyay, who allegedly did not take any care to refer the child for Retinopathy or premature screening which is a mandatory test to be conducted within the first 3 weeks of the birth of a premature child. It was further alleged that neither no effort was made to observe the minimum protocol that was needed in such cases, nor were the complainants informed about any such complication in the child at the opportune moment.

The child was readmitted to the hospital for a third time, when the deficiency in the eyesight of the child was further diagnosed, and she was referred to Sardar Vallabh Bhai Eye Hospital, where the doctors opined that ROP Stage IV and III had developed. Although, the child was taken to All India Institute of Medical Sciences (AIIMS), they were informed that it was not possible to retrieve the eyesight of the child.

Following this, a written complaint was submitted to the Principal of the medical college, and another complaint was filed before the State Medical Council. The complainants also approached the NCDRC bench and claimed Rs 1.50 crore for negligence and deficiency in service as compensation to the child and Rs 40 lakhs to the parents with an additional sum of expenses to the tune of Rs 2.5 lakhs coupled with Rs 2 lakhs towards litigation expenses. 

Based on the complaint to the medical college principal, a committee was constituted to probe the matter. According to the Complainant, the panel opined that the Pediatric Department was negligent in treating the child for ROP, and disciplinary action was recommended.

An FIR was also filed before the Police Station of the Medical College, Meerut levelling allegations so as to constitute an offence under Sections 326 & 336. This FIR was lodged mentioning about the report of the Medical Committee of the Medical College wherein an allegation was made against the HoD saying that he was responsible for negligent treatment as a result of which the child lost her eyesight.

Meanwhile, questioning the correctness of the report, the HoD Dr. Upadhyay raised his concerns before the Director General Medical and Health Services Uttar Pradesh, who set up a four member panel. This committee was of medical experts from King George Medical University, Lucknow, S.N. Medical College, Agra and the Children Hospital at Noida.

Consequently, a detailed inquiry was conducted and a report was submitted before the Director General Medical and Health Services. In the report, the Four-member panel categorically recorded that the mishap occurred not because of the doctor's negligence but on account of the attendees to the patient who did not comply with the instructions given from time to time orally as well as in writing.

Following this, the DGHS informed the Principal Secretary Medical and Health, Govt. of Uttar Pradesh that the complaint and the proceedings recommended against the HoD deserved to be dropped.

Meanwhile, the doctor also challenged the FIR before the Allahabad High Court, which directed to set up a Medical Board of inquiry. The concerned board was set up by the District Magistrate comprising of the Joint Magistrate, Meerut, and three doctors. This panel conducted a detailed inquiry and went through each an every material in detail very minutely and submitted an exhaustive report on 03.09.2016.

Relying on the report, the High Court quashed the FIR against the doctor and observed, “In the present matter, very detailed inquiry report (in 20 pages) has been submitted by the medical board and as per final conclusion of the medical board, the medical board is of the view that the allegation of negligence against the petitioner is untrue.”

The matter was also examined by the Medical Council of Uttar Pradesh and the Ethics Committee opined that Dr. Upadhyay was not negligent in the discharge of his duties and therefore, no element of lapse or guilt was established towards the professional conduct of the doctor. Against this order, the complainants filed an appeal before the Medical Council of India, which ultimately upheld the decision of the Medical Council of Uttar Pradesh.

When the matter came to be considered before the NCDRC bench, the counsel for the complainants submitted that the findings of the subsequent inquiry reports were erroneous as the Discharge Slip issued to the Complainant on the first occasion contained no advice for undergoing the ROP protocol nor were the complainants ever advised to visit the Ophthalmology Department or its experts. The child was never treated or advised by the Ophthalmology Department for any such deficiency. 

It was contended that it was the primary duty of the HoD Dr. Upadhyay to have appropriately taken care of guiding the parents for taking proper medical treatment and observing the ROP protocols. It was urged that Dr. Upadhyay did not attend the child at all and he did not give any advice and the parents kept on running about in the hospital with no indication regarding the deficiency from which the child was suffering. It was urged that as soon as this was informed to the parents, they undertook all measures as advised when ultimately on 30.11.2015, they came to know about this gross negligence which had occurred during the previous four months resulting in the loss of the eyesight of the child which according to the opinion of All India Institute of Medical Sciences could not be retrieved. Further, it was submitted that the child was taken to a Hospital in Hyderabad for surgery but with no success. 

Referring to the endorsement regarding ROP in the Discharge Slip, the complainants questioned its genuineness on the ground that it was never made known to them. They claimed that the investigation was delayed for almost four months which protocols ought to have been observed within 21 days of the date of delivery. Referring to this, they alleged that this delay and negligent attitude, particularly of Dr. Upadhyay resulted in the calamity.

On the other hand, the counsel for the doctors and the medical college contended that medical expertise was duly administered promptly and they further argued the inquiry reports established that the first inquiry conducted by the Committee of the Medical College was found to be incorrect through a proper inquiry of Directorate of Health.

While considering the matter, the NCDRC bench took note of the different versions of the complainants regarding the Discharge Slip and observed,

"...the Complainant has nowhere been able to deny the fact that the Discharge Slip was available with the Complainant at least from 21.7.2015 till 21.8.2015 as it is an admitted case of the Complainant that the Discharge Slip had been handed over on 21.8.2015 at the time of the second admission where after it is alleged to have not been returned. The allegation that it was not returned or the contradictory statement of Smt. Nazrana that it was torn into pieces by Dr. Amit Upadhyay itself explains that the Complainant had been shifting stands in spite of the fact that they were having custody according to their own case of the Discharge Slip from 21.07.2015 to 21.08.2015. It is, therefore, safe to conclude that the endorsement did exist on the Discharge Slip and does not suffer from any subsequent interpolation or tempering. It was made on the date of discharge as substantiated by the statements of Dr. Ritu Mittal and Dr. Shivam Agarwal who had attended the child during her first admission at LLM Hospital. There is no good reason to suspect or cast any doubt the same."

Regarding the endorsement of ROP Screening if the baby, the consumer court noted, "No material to the contrary exists to dislodge the endorsement of the aforesaid advice of ROP on the discharge slip and to appear before a particular OPD on 24.7.2017. This date of 24.7.2017 is clearly within three weeks of the birth of the child. It, therefore, cannot be said that there was no advice or information to the Complainants regarding ROP."

The consumer court noted that the complaint did not dispute the handing over of the Discharge Slip to the complainant. Referring to this, the Commission further observed,

"This also clearly indicates that the Complainants without having been able to dislodge the endorsement on the Discharge Slip, which is the main bone of contention, kept on raising complaints and as a matter of fact any challenge to the endorsement does not appear to have been made in any of the complaints in spite of having knowledge of the same. This is also evident that the factum of the endorsement was stated in the report dated 26.3.2016 but the FIR lodged thereafter nowhere makes any allegation of the alleged manipulation of endorsement. Even before the second or the third Inquiry Committee there was no such case set up by the Complainants so as to doubt the endorsement made on the Discharge Slip regarding ROP protocol."

Therefore, exonerating the doctor, the Commission held,

"Thus on an overall conspectus of the emerging facts the position that can be deduced is that no criminal negligence was established against Opposite Party No.1 and to the contrary in the proceedings before the Inquiry Committee as also before the Ethics Committee of the Medical Council of Uttar Pradesh as well as the Medical Council of India medical negligence could not be established on the part of Opposite Party No.1 either substantially or even remotely."

The Commission further noted that the child was not treated directly by Dr Upadhyay during the first two instances of admission. Examining the role of another doctor, the consumer court observed that the Retinopathy test had been advised at the time of discharge on the first occasion. Therefore, the Commission concluded that

"...there is neither any negligence nor any deficiency in service that can be levelled against the Opposite Party No.1 or for that matter against Opposite Party No. 2."

While considering the duty of LLRM Hospital, the Commission took note of the submissions by the doctors and the hospitals denying negligence and noted,

"It has also been stated that due care was taken and caution was advised to the parents at the time of discharge on 22.07.2015 which has been established on record and even through all the enquiries and other proceedings that were undertaken against the Opposite Party No.1. The said evidence could not be controverted nor it has been rebutted with cogent evidence to disbelieve the same."

Exonerating the doctors and the hospital, the NCDRC bench mentioned in the judgment,

"Thus, in the absence of any omission, rashness negligence much less gross negligence the allegation made against the Opposite Parties have not been established hence no relief is admissible."

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-no-medical-negligence-221905.pdf

Also Read: Infant's arm amputation case at KEM: No medical negligence, says hospital panel