Merely Displaying MD Cal In Letterhead Is Not Misleading: Commission Absolves MBBS Doctor Of Medical Negligence Charges

Presiding Member of the Commission, Dr S M Kantikar and Member, Binoy Kumar dismissed a complaint moved by an ENT specialist against Extent Medical and Surgical Centre and its five doctors alleging gross and willful negligence of the MBBS doctor towards his daughter (the patient) who eventually died. The complainant raised several other allegations like lack of informed consent, false qualification of the MBBS doctor, manipulation of medical records, and mismanagement of the patient's care, not doing proper investigations, failure to correct anemia and wrong medication etc, and sought a compensation of more than Rs 4,69,81,448/- under different heads.

The patient who was admitted to the hospital was suffering from high fever and loose motion due to the side effect of Moxclav (Amoxicillin). The patient developed urticarial rash due to side effect of medicines and doctors changed the medicines, the Inj. Pause was stopped, and Inj. Corts was started.

It was alleged that the doctor visited the patient, but he did not discontinue Inj. Levosulpiride, as it was Sulphur-containing drug, and the patient had a known allergy to Sulpha drugs as recorded in the medical history. The family of the patient was allegedly not informed about her serious condition. Thereafter, the complainant found that his daughter suffered respiratory distress. The patient’s condition further deteriorated with shortness of breath and alleged that she was shifted to High Dependency Unit (HDU) instead of ICU and put on Oxygen by CPAP machine. The patient's condition worsened, and she was shifted to the High Dependency Unit (HDU) and placed on Oxygen by CPAP machine. However, she eventually died. It was alleged that if ICU/ITU facility was not available at the hospital, the doctor should have referred the patient to another hospital.

The Authorized Representative (AR) of the complainant argued about the lack of informed consent, serious mismanagement of the patient leading to her death and that the doctors failed to carry out investigations to arrive at correct diagnosis. He further argued that the doctor committed serious fraud, his letterheads bear MD (Cal) without specifying his actual speciality and the signboard at the Centre displayed his name as a Physician along with two other doctors.

"Actually he holds MD in P & SM but mentioned as a M.D. (Cal) only to mislead the patients. His name was also reflected as a critical care consultant. It was not a valid qualification recognised by MCI in the critical care medicine. The AR brought our attention to the code of medical ethics prescribed by West Bengal Medical Council 2002 as, "Do not claim to be a Specialist unless you have a special qualification in that branch. Once you say you are one, do not undertake work outside your specialty even for your friends”. Therefore, the doctor was neither a physician nor a critical care consultant. He was committing fraud, unfair practices which deserves severe penalty," the AR submitted.

He added that the doctor holding MD degree in Social and Preventive Medicine but posing himself as a Specialist in General Medicine i.e. a Physician or a Pulmonologist did not care for ABG Report (dated 28/10/15 at 11.03 AM) with Hb% 6.8 gm/dl. His pattern of writing Prescriptions and Clinical Notes itself indicate his deficiency and careless attitude towards the patient.

Meanwhile, the learned counsel for the hospital and the doctors submitted that the patient had a history of fever since 2015 and she took treatment and once admitted to nursing home on 23.10.2015 under the care of an ENT surgeon. She underwent diagnostic tests including an X-ray of her chest, which diagnosed her with pneumonia. However, the patient did not disclose the previous treatment received from the ENT. Her fever showed high spike to 105℉ on 24.10.2015 and she consulted with an MBBS doctor. She was also treated on 26.10.2015 by her father. Few blood tests with Malaria and Dengue tests were done again. On 27.10.2015, the patient’s father took her to the said Centre with all the lab investigations. He was aware of the available services and facilities at the hospital. He did not follow the advice of doctor but chose to undergo selective tests for his daughter. The ECHO and Genexpert test advised by the doctor were not done.

The counsel further added that the doctor advised to stop inj. Doxofyllin and advised to start inj. Aminophylline1 amp 8 hourly and to continue all other medicines. On 01.11.2015, the patient was in severe respiratory distress and Dr Soubhik Panja started CPR, Oropharyngeal suction, ETT insertion and administered Inj. atropine and inj. adrenaline each 1 amp IV stat. The mechanical ventilation was started, but unfortunately, the patient could not survive. The cause of death was declared to be respiratory failure in a case of community acquired pneumonia and asthma.

Deliberating the case, in 2018, WBMC passed an Order and held that there was no medical negligence while treating the patient by the doctor. The complainant challenged the order of WBMC before the Board of Governors in Suppression of Medical Council of India, which affirmed the Order of WBMC. The Board of Governors also did not find negligence of the doctor. The Board, however, observed that inspite of the doctor being a hold of MD (Preventive and Social Medicine), his use of MD in his prescription pad and not mentioning of his Registration No. thereon was a violation of Code of Medical Ethics and the doctor be issued with a letter of caution for this violation.”

The Commission, after hearing the arguments and perusing the documents clarified on the issue of false qualification and competence of the doctor. It noted;

" The doctor was competent for the medical management of patient. Mere displaying M.D.(Cal) is no way misleading or unfair, but his clinical experience and competence has been proved by the certificates . Moreover, his basic qualification is MBBS, thus stating him as a “QUACK” was an absurd allegation made by the Complainant who himself is a doctor- ENT specialist. In our considered view, OP-1 (the doctor) treated the patient as per the reasonable standard of care. Moreover there was no Physician available in Chandannagar during 'Durga Puja' vacations."

The apex consumer commission observed that the AR and the complainant being doctors, misguided this Commission that though the patient was allergic to Sulpher (sulpha drug), the doctor continued drug Levosulpiride. It clarified;

"It should be borne in mind that Levosulpiride is not a sulpha drug, but it is a pro-kinetic agent frequently combined with Proton pump inhibitors like Omeprazole/ Pantoprazole. It can increase acetylcholine levels in the body."

"Secondly, on 31.10.2015 patient was prescribed injection Neumol (Paracetamol) 500 mg IV- QID (4 times a day). The patient became afebrile as a result of treatment only. It was continued to prevent rise of temperature which could lead to dehydration. As such patient did not suffer hypothermia. From the several medical literature, the overdose of Paracetamol is considered if it exceeds 4000 mg / day. Therefore, in our view the allegations of use of Levosulpiride and Neumol are not sustainable. It was an accepted reasonable practice. Thirdly, blood pH 4.72 appears to be an inadvertent error in writing, and by any stretch of imagination such values never observed in practice of medicine."

"As per the clinical notes dated 01.11.2015 at 7.20 AM, the on duty Medical Officer (OP-2) noted the sudden deteriorating condition of patient. There was fall in Sp02, it was 40%, PR 67/min, BP was not recordable. Immediate CPR started. Oro-pharengeal suction done, endotracheal tube inserted and IV injection Atropine and Adrenaline given in dilution. As per medical literature, injection Adrenaline is recommended in cardiac arrest and should be given IV in normal saline. The Complainant was informed and consent for intubation and mechanical ventilation was obtained over phone. After the death of patient, the OP-1(the MBBS doctor) was confronted by the hostile family members of the patient. The entire medical record was handed over along with X-ray and ECG along with the death certificate to the Complainant No.1 on the same day ."

Referring to various judgements and orders by Supreme Court and the Commission in similar cases, NCDRC opined that the complainants have just made allegations which are not an inviolable truth.

It held;

"The Complainant No. 1, being an ENT specialist practicing in that area for decades, can’t plead his ignorance on the facilities available at OP-6 hospital, the qualification and competence of OP-1 (MBBS doctor). His allegations are vague, unsustainable for use of Levosulpiride and Neumol. The patient was investigated, diagnosed and treated as per the reasonable standard of practice, thus no negligence is attributable to the OPs (hospital and the doctors).

Our view dovetails form the judgment of Hon’ble Supreme Court in Devarakonda Suryasesha Maniv Care Hospital, Institute of medical Sciences[10], wherein it was held as below: “..2. Unless the appellants are able to establish before this Court any specific course of conduct suggesting a lack of due medical attention and care, it would not be possible for the Court to secondguess the medical judgment of the doctors on the line of medical treatment which was administered to the spouse of the first appellant. In the absence of any such material disclosing medical negligence, we find no justification to form a view at variance with the view which was taken by the NCDRC.

“Every death in an institutionalized environment of a hospital does not necessarily amount to medical negligence on a hypothetical assumption of lack of due medical care.”

Subsequently, the Commission dismissed the complaint as no merit to conclusively attribute medical negligence of the opposite parties (the doctors and hospital) was found.

To view the original order, click on the link below: