Wrong Diagnosis not Medical Negligence: Supreme Court junks Medical negligence claim

We appreciate the pain of the appellant, but then, that by itself cannot be a cause for awarding damages for the passing away of his wife. We have sympathy for the appellant, but sympathy cannot translate into a legal remedy.

Jaipur: Holding that a case of the wrong diagnosis cannot be equated to medical negligence, The Supreme Court has recently upheld the decision of National Consumer Disputes Redressal Commission  (NCDRC) for quashing the State commission’s decision of holding a doctor and hospital guilty for alleged medical negligence. The Supreme Court also exonerated the doctor from the allegations.

The case concerns a female patient, with a previous history of oesophageal cancer (colon and breast cancer), hypertension and type 2 diabetes, who was admitted to Santokba Durlabhji Memorial Hospital (SDMH) Jaipur on 15.10.2011 under Dr Anurag Govil with complaints of chills and fever. A  nasal feed tube was inserted on the same day, stated to be dislodged due to severe dysphagia. Few other tests were prescribed.

One of the tests was a Complete Blood Count Report, which found that the WBC count was high, indicative of infection. She had also running temperature of 104 degrees Fahrenheit, and her medical treatment commenced with intravenous administration of injection Magnex of 1.5 mg.

As per the medical reports, the cannula used for intravenous treatment stopped functioning and the doctor prescribed a further antibiotic tablet, Polypod (Cefpodoxime) to be orally administered through the nasal tube.

The patient was discharged from the hospital on 18.10.2011. The patient had her WBC count high and she was prescribed to continue taking her medicines for a period of 5 days post discharge, which apparently was administered to her, as per the appellant.

The complainant in his complaint informed that on 23.10.2011, and had to be admitted to a nearby Heart and General Hospital, where she was put on life-support ventilation system. The WBC count of the wife of the appellant had risen even further and the systolic BP was only 40. Her health continued to deteriorate and she was required to be shifted to the Fortis Escorts Hospital, where she died on 31.10.2011.

A case of medical negligence was filed against a doctor and hospital with the Rajasthan Medical Council which dismissed the complaint holding no case of medical negligence  was found in the given facts of the case. The process of coming to this conclusion included the response of the treating doctor to a panel of eleven doctors, which scrutinized the complaint and the material placed before the panel, by the appellant.

The further appeal of the appellant, before the Medical Council of India (MCI) was rejected as time barred on 8.3.2013.

The appellant then moved to the State Consumer Disputes Redressal Commission, Rajasthan which held its judgment in favour of the complainant by ruling compensation of over Rs 15 Lakh. The Respondents then filed an appeal at NCDRC which exonerated the doctor and the hospital.

The complainant moved to the Supreme Court against the reasoning of NCDRC.

The appellant sought to make out a case of: (a) inappropriate and ineffective medication; (b) failure to restart the cannula for IV medication; (c) premature discharge of the deceased despite her condition warranting treatment in the ICU; (d) oral administration of Polypod antibiotic, despite her critical condition, which actually required intravenous administration of the medicine.

The doctors in their defence informed that when the patient was discharged, she was afebrile, her vitals were normal and she was well-hydrated, with no infection in her chest or urinary tract. She was stated to be clinically stable from 15.10.2011 to 17.10.2011 and that is why she was so discharged on 18.10.2011, with proper medical prescriptions for the next 5 days.

The apex court after going through the matter dismissed the complaint, stating that the case can be termed as that of wrong diagnosis, not of medical negligence

It was opined that at the highest, it could be termed as a case of wrong diagnosis and certainly not one of medical negligence.

 

The SC went through the literature of the previous cases of Medical Negligence.

The Supreme Court also noted  that the hospital promptly attended to the wife of the appellant. The treating doctor, physician, also attended to her promptly, and started her on antibiotic treatment. The nasal feed tube was re-inserted promptly.

However, in the early hours on the next day, on 16.10.2011, the cannula stopped functioning and instead of re-cannulating the patient, oral administration of the antibiotic Polypod was found justified. It is this aspect, which according to the appellant, amounts to medical negligence. The explanation offered by respondent the treating doctor was that when he attended the patient at 11:00 a.m. on 16.10.2011, he found that the drip had been disconnected, on account of all peripheral veins being blocked due to past chemotherapies, and that the drip had been stopped, the night before itself, at the instance of the appellant. Taking into consideration the fact that the patient was normal, afebrile, well-hydrated and displayed normal vitals, the oral administration of the tablet was prescribed.

The Supreme Court stated:

We see no reason to differ from the view expressed by the NCDRC, keeping in mind the test enunciated aforesaid. The doctor, who was expected to bring a reasonable degree of skill, knowledge and care, based on his assessment of the patient, prescribed oral administration of the antibiotic in that scenario, especially on account of the past medical treatments of the wife of the appellant, because of which the veins for administration of IV could not be located. Her physical condition was found to be one where the oral administration of the drug was possible.

The court upheld the decision of the NCDRC

In our opinion the approach adopted by the NCDRC cannot be said to be faulty, while dealing with the role of the State Commission, which granted damages on a premise that the doctor could have pursued an alternative mode of treatment. Such a course of action, as a super-appellate medical authority, could not have been performed by the State Commission. There was no evidence to show any unexplained deviation from standard protocol. It is also relevant to note that the deceased was medically compromised by the reason of her past illnesses.

The Supreme Court further added:

The deceased was admitted to two other hospitals, post her discharge from respondent Hospital. The moot point was whether her admittance and discharge from the hospital was the sole, or even the most likely cause of her death. The death had been caused by a multiplicity of factors. In the end, we may also note that the medical certificate issued for the cause of death by Fortis Escorts Hospital cited septic shock due to multiple organ failure as the immediate cause of death, with her diabetic condition being an antecedent cause, as also the multiple malignancies, post chemotherapy and radiotherapy all contributing to her passing away.

With this the court dismissed the complaint, absolving the doctor of any medical negligence