Inaccurate Antenatal detection: Uttrakhand Medical Council suspends Radiologist's licence

The radiologist has been suspended for over 3 months on the recommendations of the disciplinary committee of the medical council.

The matter came to fore after the complaint registered with the chief medical officer (CMO) in Dehradun reached the doors of the state medical council.

The case goes back to the year 2018. In his complaint, a man had submitted that his wife was 9 weeks pregnant when the couple consulted radiologist between April and June that year.

As per the complainant, the radiologist kept telling them that the baby was fine, but when the child was born, the baby's lips and palate were severed. Even the child's heart was displaced. He was unwell too. The parents then approached the chief medical officer (CMO) in Dehradun who then transferred the matter to the UMC.

Considering the complaint, the Uttarakhand Medical Council created a team of expert panellist from the AIIMS who found that the radiologist must have gone for 3D ultrasound, in case he had doubts on the 2D one.

The ethics committee at the medical council noted that the Scan dated 16 June 2018 was level 2 for ruling out congenital anomalies. Reports from none of the scans provided reveal about 2D/3D nature of the scan. From the images attached it could be deciphered that the scans are 2D. Level 2 scan for ruling out congenital anomalies has some basic requirements as per national and international standards.

On the perusal of the reports, the experts and the committee found that the said level 2 ultrasound report had clearly stated that no cleft lip or palate is seen, however, the baby had both these anomalies. Review of literature from various sources report a detection rate of cleft lip + cleft palate in present scenario to be from 9% to 100% of detecting these anomalies. In case of any ambiguity/doubt on 2D images.

3D ultrasound should have been suggested instead of reporting it as normal, the committee observed.

It was further observed that the report did not comment upon the heart. As per guidelines of level 2 scan, at least a four-chamber view must have been mentioned in the report. Detailed examination of the heart involves foetal echocardiography. Any abnormality or doubt in four-chamber view should invite recommendation of foetal echocardiography.

"In this case, the four-chamber view was not reported which could have provided a hint about cardiac anomalies and would have prompted for detailed foetal echocardiography. In addition. child was also found to have dextrocardia post-natal evaluation. The level 2 ultrasound report dated 16 June 2018, clearly states that both kidneys are normal. In the postnatal scan the right renal fossa was empty and there was crossed fused ectopia of the right kidney in this scenario level 2 report should have reported an empty right renal fossa."

Foetal wellbeing scan is not supposed to look for detailed congenital anomalies, hence non-reporting of these anomalies in scans dated 16 April 2018 & 16 October 2018 done for foetal wellbeing is not a lapse on part of the radiologist. However, the committee held that "the level 2 scan done on 16 June 2018 is not up to the standard of care as per current national and international guidelines."

After this thorough probe, the three-member expert committee of All India Institute of Medical Sciences (AIIMS Rishikesh) considered that the radiologist was guilty of medical negligence, as per the order issued by the medical council, a copy of which is with the Medical Dialogues.

"We have cancelled the registration of the doctor for three months which will be in effect from January 2021. Two months' time has been given to the doctor in case he wants to approach the Medical Council of India (MCI). He has also been instructed to get radiology training again for one month from a competent centre as per his wish during the suspension period. At the same time, we have also directed the authorities of the concerned centre to appoint only skilled radiologists in its institute in future," Dr YS Bisht, Registrar Uttarakhand Medical Council confirmed TOI.

In response, the doctor has denied all the allegations against him. In a statement, has said that he felt he has been wronged by the verdict which he feels is "illegal" on legal as well as the scientific basis.

"According to standard textbooks, the accuracy of antenatal detection of facial clefts is 16-93 per cent. How can postnatal detection of a cleft be constructed as negligence when the world literature says the image is never 100 per cent," the radiologist told TOI adding that a doctor is liable for the punishment when there has been damage caused to the patient as a result of his act of omission or commission and both were not there in this case.