No Medical Negligence during Cataract Surgery: NCDRC exonerates Opthalmologist, Eye Hospital

New Delhi: Setting aside the orders of both the District Forum and the State Commission, the National Consumer Disputes Redressal Commission (NCDRC) recently exonerated a Delhi-based opthalmologist and an Eye Centre from charges of medical negligence during cataract surgery.

It had been alleged by the complainant that she had developed post cataract Endophthalmitis due to alleged negligence during cataract surgery.

However, after perusing the medical record and the expert opinion Dr. R.P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, the top consumer court exonerated both the doctor and the hospital and noted, "Both the fora didn't consider the medical grounds and the evidence, erred to hold Petitioner liable for medical negligence. In our view, it is a material irregularity apparent on record."

The matter goes back to 2004 when the complainant was suffering from cataract in her right eye with age related macular degeneration. Therefore she had approached Dr Ina Jain, who performed right eye cataract surgery on the patient. After being discharged, the complainant approached the doctor with complaint of unclear vision. 

After examining the patient, Dr Jain noted inflammatory reaction and membrane in pupillary area. Therefore, the doctor advised antibiotics and other medicines. The doctor also gave subconjunctival injection to the patient for the next two days and her inflammation in the right eye got controlled and the condition of the patient became stable.

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Therefore, the patient was referred to an expert Vitreo Retinal Surgeon at Navjyoti Eye Centre to assess any source of inflammation in the vitreous cavity. The doctors of Navjyoti Eye Centre had done a Vitreous tap and it revealed early signs of Endophthalmitis in the vitreous cavity. Therefore, as per the standard protocol intravitreal injection was given and she was kept under observation for 36 hours. There was no desirable response to the treatment; therefore, she was referred to Dr. Lalit Verma another Vitreo Retinal Expert for further management.

The complainant alleged that the post cataract Endophthalmitis was due to alleged negligence during cataract surgery. Partly allowing the complaint, the District Forum had directed the petitioner to pay Rs 1,76,392 along with interest @ 9% per annum from the date of filing. When the doctor and the hospital filed the First Appeal before the State Commission, it was dismissed.

When the matter reached the top consumer court, it considered the submissions made by both the parties, perused the entire medical record and also expert opinion from R.P Centre at AIIMS, New Delhi.

The top consumer court also noted the fact that the District Forum did not seek any expert opinion. However, the doctor and hospital had appealed before the State Commission for the opinion from the Medical Board.

It was opined by the expert panel that-

"(1) After proper pre-operation care and antibiotics, successful surgery was performed, and respondent was asked to come in 5 days, and earlier if any problem arose. She came on 8th day with a bound-down pupil papillary membrane. No other signs. Vn PR full. Cycloplegics and sub-conjunctival steroid antibiotic injections started, repeated every 12 hours.

(2) When no progress noted respondent was referred to Dr. Vivek Pal for 2nd opinion, Vitreous tap and intra-vitreal anitibiotics were given there.

(3) The appellant waited for 24 hours for intravit injection but since there was no response, the appellant immediately sent the respondent/patient to Dr. Lalit Verma for victrectomy.

(4) The appellant had followed the prescribed treatment protocol for such a patient."

The NCDRC bench also referred to the report by Dr. R.P. Centre for Ophthalmic Sciences, AIIMS, New Delhi. It revealed, "From the records provided to us by Dr. Ina Jain vide their letter dated Oct. 30, 2009, it looks that the patient has suffered from Post-operative Endophthalmitis which is a known complication. When the case was diagnosed as Endophthalmitis, the case was appropriately managed and referred as per standard procedure."

Besides, the prescription given by the doctor revealed that the patient suffering from cataract along with the problem of age related macular degeneration. Referring to this, the top consumer court observed that the State Commission had erred and noted, "There was retinal degeneration; therefore, the restoration of vision was not important. However, cataract surgery is necessary to prevent complications of hyper mature cataract like complete blindness, severe pain in the eye, headache and vomiting etc. Therefore, the Opposite Party-1 correctly advised the surgery as per standard medical practice. It was also correct to control the intraocular infection (Endophthalmitis) vitrectomy is a proper treatment to save the eye. The State Commission erred to consider the expert medical opinion of AIIMS which was relevant for deciding the appeal."

Referring to the medical record, the bench noted, "Considering the entirety of the case, admittedly the Petitioner performed cataract surgery and thereafter, during follow-up the Petitioner immediately suspected post-cataract Endophthalmitis and had given initial intravitreal antibiotic injection as an important conservative management when the conservative management did not yield good response the patient was referred to the vitreo retinal surgeon to find out the source of infection. The patient was further examined by two vitreo retinal specialists who treated her, but there was no cure from Endophthalmitis."

Relying on the expert medical opinion, the bench opined that there was no medical negligence on the part of Dr. Jain and stated in the order, "It is known from various literature and standard books on ophthalmology that postoperative Endophthalmitis is a known complication in 0.5% cases. Relying upon the opinion of the AIIMS Board of Experts and the treatment record of two vitreo retinal surgeons, in the instant case, we don't find any negligence in the cataract surgery performed by the Petitioner. The post cataract care is as per reasonable standard of practice in the field of ophthalmology. Therefore, medical negligence cannot be attributed to the Petitioner Dr. Ina Jain."

The top consumer court also referred to the Supreme Court's order in the case of Jacob Matthew, where the top court had noted that "When a patient dies or suffers some mishap, there is a tendency to blame the doctor for this. Things have gone wrong and, therefore, somebody must be punished for it. However, it is well known that even the best professionals, what to say of the average professional, sometimes have failures. A lawyer cannot win every case in his professional career but surely he cannot be penalized for losing a case provided he appeared in it and made his submissions."

Therefore, holding both the District and State Commission wrong, the NCDRC noted, "Both the fora didn't consider the medical grounds and the evidence, erred to hold Petitioner liable for medical negligence. In our view, it is a material irregularity apparent on record."

Dismissing the complaint, the bench observed, "Based on the foregoing discussion, the instant Revision Petition is allowed, the Orders of the fora below are set aside. Consequently, the Complaint is dismissed."

To view the order, click on the link below.

https://medicaldialogues.in/pdf_upload/ncdrc-order-181607.pdf

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