Failure to diagnose subluxation of intraocular lens: Delhi Hospital, Ophthalmologist slapped compensation for negligence

New Delhi: The State Consumer Disputes Redressal Commission held a private hospital and its ophthalmologist guilty of negligence while conducting surgery for "Immature Scale Cataract".

After the surgery, the Intraocular Lens (IOL) got subluxated within a day of surgery and even after the complainant reported the symptoms, the doctor failed to diagnose the subluxation of the intraocular lens in the right operated eye of the patient, noted the State Commission. Therefore, it upheld the District Consumer Court's order directing the hospital and doctor to pay Rs 1 lakh as compensation to the complainant patient.

The matter concerned a 67-year-old patient, the complainant in the case who had a history of gradual diminution of vision in her both eyes for the last 6-7 months; she visited the treating hospital for check-up. After examining her and conducting the necessary tests, the treating doctor, Dr Garg, an eye specialist, informed that the complainant had "Immature Scale Cataract RT Eye" and it would require surgery. The doctor allegedly assured the complainant that she would have good vision after the surgery. 

Consequently, she was operated by the doctor on 07.10.2011. Foldable intra Ocular Lens implantation was done and the complainant was discharged in the evening. During the follow-up visits, the patient was reexamined by the doctor and her bandage was also changed. Soon after her bandage was removed, the patient informed the doctor that there was no improvement in her eye vision and she was feeling severe pain also.

After that on 19.10.2011, the complainant went to GTB Hospital and was examined by the doctors at Eye Clinic in Ophthalmology Department. After examination at the hospital, she was told that the implanted lens had subluxated towards the left in the operated eye and at this stage, no subsequent operation was advisable, so medicines were prescribed. 

As the complainant had severe pain and watering eyes continuously and was unable to perform her routine work which had caused immense mental harassment and financial loss, she filed the complaint and claimed compensation for loss of vision due to faulty operation for a sum of Rs 5 lacs with litigation charges of Rs 11,000. 

On the other hand, the hospital and doctor denied all allegations of the complainant and prayed for the dismissal of the complaint. According to them, the hospital had all the required infrastructures and well-equipped operation theatre to combat all the types of emergency. Further, it was submitted that all the staff and attending doctors were experienced and qualified and therefore, there was no deficiency in the said operation.

They also submitted that no expert opinion was taken to prove the deficiency or negligence in the case. According to the hospital and doctor, post-operative complications such as Subluxation/Decantation of IOL could be correctable by any eye surgeon. However, the complainant did not come for a follow-up after a single visit. 

After considering the arguments, the District Commission passed an order on 24.09.2016 directing the hospital and doctor to pay a lump sum compensation of Rs 1 lac, jointly and severally, within 30 days after receiving the order.

Challenging this verdict, the hospital appealed before the State Consumer Court. While considering the matter, the State Commission took note of the medical history and noted that the hospital and doctor could not place any substantial evidence before the District and State Commission to support their averments that no anomaly was noted in the eyes of the Respondent during the post-operative period. 

"Thus, we find that not only the Appellants failed in diagnosing the subluxation of the lens but also ignored the need for a proper reexamination of the right eye of the Respondent. As a result, the aforementioned facts establish the prima facie gross medical negligence on the part of Appellants," observed the SCDRC.

The Commission also referred to the report published by 'American Academy of Ophthalmology' stating that "With relation to cataract surgery, IOL dislocation may be categorized based on the timing of its presentation – early if it occurs within three months of IOL placement, and late if it occurs three months after IOL placement. Early dislocation of the lens may occur with poor fixation of the IOL or capsular and/or zonular rupture during cataract surgery."

Further, it noted that it was evident that the operating doctor "was negligent in performing the surgery as the intraocular lens (IOL) got subluxated within a day of surgery and even after reporting the symptoms by the Respondent, the Appellant no. 2 failed to diagnose the subluxation of the intraocular lens in the right operated eye of the Respondent."

"Therefore, combined analysis of the abovementioned shortcomings during the treatment and the negligence culled out by the District Commission through the impugned judgment, we are of the opinion that such recurrent negligent conduct is against medical ethics and is intolerable in light of the casual attitude of the treating doctors towards the patient," it opined.

Holding that the District Commission's order did not suffer from any anomalies, the State Commission bench noted, "Consequently, we find no reason to reverse the finding of the District Commission and uphold the order dated 24.09.2016, passed by the District Consumer Disputes Redressal Commission (East), Govt. of NCT of Delhi, Convenient Shopping Centre, 1st Floor, Saini Enclave, Delhi-110092. Resultantly, the present Appeal stands dismissed with no order as to costs."

To view the order, click on the link below: 

https://medicaldialogues.in/pdf_upload/delhi-scdrc-251392.pdf

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