Higher Degree of Gross Negligence is Required to Hold a Doctor Liable- NCDRC Exonerates Neurologist, Hospital

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently exonerated a Hyderbad-based hospital and neurologist from charges of medical negligence after reiterating the Supreme Court's directions that a much higher degree of gross negligence to hold a medical professional liable for any such act.

"The law of negligence in the medical profession was discussed in the case of Jacob Mathew Vs. State of Punjab (2005) 6 SCC 1 the ratio whereof requires a much higher degree of gross negligence in order to hold a medical professional to be liable for any such act... In the instant case, in view of the facts on record and as discussed herein above, I do not find this to be a case of gross medical negligence as alleged by the Complainant and therefore, I do not find any reason to hold the Opposite Party No.2 liable for any of his acts for any loss or damage to the Complainant. The Complaint is accordingly dismissed," observed the Apex Consumer Court.

Filing the consumer complaint, the complainant alleged that the treating doctor, HoD Neurology of Yashoda Hospital, Hyderabad, failed in his diagnosis to treat the complainant for CNS Vasculitis that has now been confirmed from the medical reports on record, and instead persisted with his line of diagnosis of Multiple Sclerosis (MS). The complainant relied on the findings and reports of the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore. 

The complainant alleged that he suffered severe spasticity in the lower limbs and therefore, was unable to effectively walk and discharge his physical functions. He contended that on account of an incorrect diagnosis, medicines were incorrectly administered and the line of treatment adopted by the treating hospital and doctor was not required at all. Further, he alleged that the tests carried out also did not confirm multiple sclerosis and therefore not only the diagnosis, but the treatment was conducted by ignoring the expert opinion from NIMHANS, which amounts to a gross negligence causing suffering and loss to the complainant, who had been virtually crippled on account of medical negligence on the part of the treating doctor.

Since 2009, the complainant had been experiencing complaints of neurological ailments with recurring episodes that seemed to have emanated with symptoms of constipation. He was experiencing difficulty in walking in August 2010, involving the right lower limb with weakness of the left lower limb. He also experienced urinary disturbances and approached the treating doctor in his hospital, where the doctor diagnosed him for multiple sclerosis (MS).

This diagnosis was sought to be confirmed through oligoconal bands tests. This was rendered negative. Thereafter, the treating doctor prescribed an MRI scan together with other tests for diagnosing the same. After recording the symptoms of the Complainant as well as the other background of the case including the status of his vitals, a doubt was expressed in the diagnosis about Acute transverse myelosis (?) infective (?) and demyelinating. The discharge summary recorded the patient had been treated symptomatically who gradually improved and therefore was discharged on the same day in a stable condition. 

As per the patient, he still had difficulty in walking and was feeling uncomfortable as a result he again approached the treating doctor who examined him on 01.10.2010 and advised an Interferon injection, namely Avonex in dosage of 1 ampule once a week to be continued for three months. However, the condition did not improve and the complainant continued to walk with the help of a stick thereafter.

When the complaints of severe lower limb spasticity continued, after examining the patient, the doctor advised the installation of Baclofen pump for being fitted in the complainant's back to directly administer medicines in the spinal area. For this, a surgery was to be carried out which was accordingly conducted based on the doctor's advise. 

However, the report by NIMHANS showed that the patient was not suffering from multiple sclerosis. Allegedly, despite the NIMHANS report, the treating doctor insisted on his own line of treatment.

On the other hand, the counsel for the treating doctor and hospital insisted that the patient was looked after and cared for to the best of capability and the capacity of the treating doctor, a neurologist of world repute.

While considering the matter, the Apex Consumer Court noted that there was no doubt about the capability and capacity of the treating doctor as a neurosurgeon. 

'The MRI scan reports and the pathological test may not have been helpful exactly diagnosing the disease. The tests did not establish the claim of the Complainant about vasculitis. In between comes the report from NIMHANS on which heavy reliance has been placed by the Complainant and has been extracted herein above. The documents which have been sent along with the report dated 20.06.2017 by NIMHANS contains an evaluation by their team where one of the resident doctors indicates the diagnosis of multiple sclerosis. This is contained at internal Page-8 of the clinical history sheet prepared by the Department of Neurology. There was another opinion in between the team at NIMHANS. However, the said opinion after being discussed with Dr. Rose Dawn on 27.03.2012 indicates that the overall picture was unlikely of multiple sclerosis. However, the word vascular has been used with a question mark meaning thereby that there was no firm opinion about vasculitis as well. This was suspected but not finally diagnosed. This is reflected in the letter dated 20.06.2017 where the diagnosis is of relapse of immune mediated neurological illness. Even though multiple sclerosis was referred to less likely, there was no firm opinion about vasculitis either," observed the NCDRC bench.

Therefore, the Commission noted that

"In the absence of any definite opinion on this count, it is not possible to judicially come to a conclusion that the Opposite Party No.2 was guilty of gross negligence when he had taken steps that was in his opinion appropriate for treating the patient as per medical protocol. The expert opinion of Dr. Kaul also indicates that the treatment that was meted out to the Complainant on the basis of the diagnosis on record was backed up by pathological reports, radiological analysis as well as clinical examination after physically examining the patient. This entire overall effort by the Opposite Party No.2, in our opinion, does not fall in the category of a medical negligence much less gross medical negligence."

"The material and literature relied upon by the learned Counsel for the Complainant therefore, also does not lead to the conclusion that the diagnosis made by the Opposite Party No.2 of multiple sclerosis was perverse or contrary to norms, out of which one was the McDonald criteria. The same literature also states that spinal cord vasculitis is exceedingly rare and there are very few cases around the world that have been reported to have been diagnosed correctly. Thus, every symptom of Spasticity cannot be equated with vasculitis. One of the medical literatures on record indicates that only five such cases had been located during a 21 year period with the spinal cord involvement. Not only this, the treatment of vasculitis is almost similar to that of multiple sclerosis and the medicines administered were closely in tandem that did not create any adverse effect," it further noted.

The Commission observed that to confirm that the diagnosis was palpably wrong and against all medical protocols, the treating doctor exercised the best options in consultation with NIMHANS and even otherwise had devoted himself to the treatment of the Complainant every time the Complainant had approached the treating doctor. Accordingly, it dismissed the consumer complaint.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-264938.pdf

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