NCDRC holds Ophthalmologist negligent during cataract surgery, slaps Rs 2 lakh compensation

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently held a Delhi based Ophthalmologist guilty of medical negligence while conducting cataract surgery of a patient, who faced vision loss.

Directing Dr RP Singh to pay Rs 2 lakh as compensation to the patient, the top consumer court observed, "The frequent laser therapy administered by the respondent have destroyed the blood vessel growing in the choroid below, and sealed leaky areas, as well as destroyed the overlying retinal tissues creating a blind spot in the area of treatment and deteriorated the photo receptive cells, leading to loss of central & peripheral vision completely."

The history of the case goes back to 2003 when the complainant underwent left eye cataract surgery +IOL implantation at Dr RP Singh's Sarvodaya Hospital, affiliated with Visitech Eye Hospital, Delhi. The petitioner alleged that Dr Singh was negligent while conducting the cataract operation resulting in the reduction of his vision.

Following this, he took treatment at Kolkata and at Eye Centre, AIlMS, New Delhi, but did not get relief. Therefore, he filed a consumer complaint before the District Forum. Although the District Forum had awarded compensation, when the matter reached the State Commission, it dismissed the complaint.

Also Read: SC upholds MCI findings, sets aside Consumer Court order absolving surgeon, hospital of medical negligence in laparoscopic cholecystectomy

Dr Singh denied any negligence and claimed the operation was conducted in accordance with the standards and it was successful as well. He further claimed that after being discharged the patient had been checked at the OPD and his corrected vision was 6/12. On fundal examination, there was an elevation of interior portion of retina with fluid collection. Therefore, re-surgery with silicon eye injection was advised to ascertain the advice the Complainant took the second opinion from HOD vitero retina at R.P. Centre, AIIMS who also advised the same.

It was submitted by the doctor that the patient had visited several hospitals in Kolkata wherein the doctors followed the same treatment as given by him and the best-corrected vision of the complainant was improved to 6/18. The complainant had returned for follow up after a week and on examination, his retina was found to be well attached and intraocular pressure (IOP) were within normal limits. Therefore, there was neither any negligence nor any deficiency in service, submitted the doctor.

Meanwhile, the Ethics Committee of MCI had been considering the matter and in its meeting held on 20.12.2012 had upheld its earlier decision that during the cataract surgery of the complainant, the complication of posterior capsule rent occurred. Subsequently, retinal detachment occurred and the patient had to undergo a number of surgeries including laser procedures, but did not get a complete cure.

"Following phaco-surgery of Sh. P. C. Jain for cataract on his left eye by R. P. Singh there was posterior capsular rupture with lens matter falling in vitreous and prolapse of vitreous in anterior chamber. The patient was not informed by Dr. R. P. Singh about the complication happened during the surgery. There was lack of communication on the part of the doctor after cataract surgery. The patient came to know about the complainant from the other eye surgeons. In the light of above, the Ethics Committee observed that Dr. R. P. Singh has violated professional misconduct, Etiquette and Ethics Regulation, 2002 and decided that the name of the doctor be removed from the IMR for a period of six months," it had been opined by the Ethics Committee in its order dated 20.04.2015.

After perusing the medical record and going through the sequence of events from the record, the bench noted,

"It is evident from the record that the after the cataract surgery, on the next day the Complainant experienced severe pain in left eye and he consulted nearby doctor who after examination informed that the lens matter was still retained in vitreous area. Those findings were confirmed by Dr. Bharti Gupta at Eye Care Centre, at Faridabad on 13.02.2003 and by Dr. A. K. Grover on 14.02.2003. The observations of Ethics Committee of MCI are consistent that after Phaco-surgery there was posterior capsular rupture with lens matter falling in the vitreous and some vitreous seen in anterior chamber. Dr. R.P. Singh did not inform the patient about the said complication occurred during the surgery; which the Complainant came to know from the other eye surgeons."

The bench also referred to standard textbooks of Opthalmology and cataract surgery. It was noted by the bench that some excerpts from Johns Hopkins Medical Encyclopaedia revealed that during phaco-aspiration due to deeper incision made to break the nucleus, there is possibility of retinal detachment. If it remains untreated which may consequently cause development of black floaters in vision and allowing vitreous fluid to leak between retina and RPE within 24 hours after 1st surgery.

The restoration of vision depends on whether the part of retina containing the macula was detached, if so the duration of detachment. In the event the macula was not detached, the outcomes-restoration of vision-are very good otherwise despite reattachment, proliferative vireo- retinopathy or scaring develops and outcomes are remote, further observed the bench.

At this outset, considering the facts of the case, the NCDRC bench held,

"The frequent laser therapy administered by the respondent have destroyed the blood vessel growing in the choroid below, and sealed leaky areas, as well as destroyed the overlying retinal tissues creating a blind spot in the area of treatment and deteriorated the photo receptive cells, leading to loss of central & peripheral vision completely."

Therefore, the bench denied accepting the submissions made by the doctor and noted,

"Moreover, the submission of the Opposite Party is not acceptable that the Complainant had fall from the staircase which was the cause for retinal detachment. It is pertinent to note that the Opposite Party has not mentioned it in the history recorded by him on 14.06.2003. But it was mentioned in the discharge summary which creates doubt on the genuinity of the document. As per medical texts, it is not possible displacement of normal retina with such fall unless there is any penetrating/piercing injury to the eyes."

To read the court order, click on the link below.

https://medicaldialogues.in/pdf_upload/ncdrc-cataract-surgery-177786.pdf

Also Read: Urinary Bladder cut during emergency operation for labour: Nursing Home directed to pay Rs 4 lakh compensation