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Careless USG report costed doctors Rs 15 lakhs as unethical practice

Careless USG report costed doctors Rs 15 lakhs as unethical practice

USG Report given carelessly amounts to unethical practice and thus costed Rs.15 lakhs to Drs..

(In my opinion, this case is yet again another reason to amend MTP Act)

In a case of ANIL DUTT & ANR. V/s. VISHESH HOSPITAL, INDORE & ORS., the National Commission passed strictures upon the Radiologists / Sonologists for not adhering to  the Hippocratic Oath !

Case of the Complainant. :
1. The Wife of the Complainant was under treatment of Doctors during her pregnancy. IT was contended that the concerned sonologists / radiologists gave wrong reports at both occasions after 20 weeks ,which resulted into serious consequences.Namely, the patient was advised for ultrasonography (USG) by Dr. Indira Vyas, a Gynaecologist to ensure well-being of child, it was done on 20.01.2009 by Dr. G.S.Saluja, (the OP3), and reported it as intrauterine 20 weeks and 6 days gestational age, with no abnormal findings.  The “Foetal Spine, Trunk & Limbs are Normal”. On the basis of the said report Dr. Indra Vyas continued her regular treatment and check-ups. After 3 months, i.e at 32 weeks of pregnancy, on 22.04.2009, 2nd USG was performed by OP2 Dr.Kushalendra Soni. It was reported as 32 weeks 01 day( + 2 weeks) “ Severe Oligohydramnios” and the  “Foetal Spine, Trunk & Limbs are Normal”.

2. When the female-baby was born, she was found not fully developed & her left arm and kidney were missing and even lungs were not completely developed and had fused spinal cord. The foetal weight was only 1500 gm, instead of 2500 gm.

3. The allegation of complainants was  that, both the doctors, OP2 and OP3 are qualified Radiologists/Sonologists, but due to casual approach, negligence and lack of care towards the patient, gave wrong reports at both occasions, which resulted into serious consequences. The other Doctors opined that due to wrong USG reports, the no proper treatment was given for mother and child before birth and due to wrong reports, the parents lost their option of MTP. The mother was under shock after seeing her baby and underwent bypass surgery.

4. Hence, the case for Compensation of Rs.1.5 Cr.

Doctors’ Defense :

1.Organ imaging is largely dependent upon position of foetus and to recognise absence of structure that ordinarily could be visualized with most difficulty. Routine ultrasound is the most basic form of prenatal examination and lasts only for about 10 minutes during which the position of foetus cannot be changed to view it from sides.Every qualified radiologist and gynaecologist is fully aware of the inherent limitation of such USG. During the USG performed by him, the foetus was lying on its side, with upper limbs tucked underneath, it was impossible to see that any limbs were missing nor was there any reason to assume or suspect so. The congenital anomaly suffered by the child rather very rare and extremely difficult to detect even with repeated examinations with the best expertise and modern equipment. The routine scan cannot detect such anomalies, it needs advanced targeted or anomaly scan.

2. The anomaly scan should have been directed by the treating Doctor as the type of examination depends upon which examination is requested by the gynaecologist concerned.

Held :
1. The National Commission, after going through the medical record, experts opinion and after hearing of parties, allowed the Complaint to the tune of Rs.15 lakhs.

2. It relied upon the Apex Court judgment of V. Kishan Rao Vs. Nikhil Super Speciality Hospital & Anr., 2010 CTJ 868 (SC) , wherein it has been held that only in complicated cases, expert opinion is required.

3. Dr. R.K. Sharma, who is a forensic expert opined that it was a clear case of Medical Negligence where sonologists/radiologists failed in their basic duty to detect congenital malformation. On the contrary, the Expert opinions on behalf of Doctors stated that any amount of detailed study by ultrasonography, may miss the congenital anomaly at the expert hands and cannot amount to negligence with availability of even ultra-modern equipment.

4. The Court observed that the doctors are often reluctant to testify against their colleagues (as the “conspiracy of silence”) and hence true experts opinions are hard to be found.

5. Had the anomaly been detected the parents would have been referred to a tertiary foetal medicine unit for further investigations which would have revealed the presence of other anomalies in addition to the abnormalities of the foetal limbs. The existence of two serious anomalies would have resulted in the pregnancy being terminated.

6. As per their own submissions,of Sonologists that because of tucked position of the foetus, they have not seen the limbs, then how both opined in their “usual” reports as “Foetal Spine, Trunk & Limbs are Normal, the National Commission straightly pointed out the variance.

7. The Doctors failed to exercise the reasonable degree of care and skill during performing USG.The deficiency in service/ breach in duty is proved against Doctors, but the anomaly was not due to the breach of duty as it was pre-existing.

Based on the findings, the court ordered OPs (1,2 and 3) to pay a sum of Rs.15,00,000/-  jointly and severally to the complainants. It is further directed that, the OPs shall deposit entire amount in a fixed deposit, in any nationalised bank, in the name of the child and the regular periodic interest accrued on it, be paid to the mother, till the baby attains 21 years.

Rs. 15 lakhs is very paltry sum from point of view of parents. But what was the real negligence on part of Doctors ? Are the limitations of USG are set out in this judgement ? What If anomaly scan is not possible prior to 20 weeks and MTP is not allowed after 20 weeks, who is at fault ?…..

An eye opener for everyone…..


Adv. Rohit Erande

You can read the copy of the judgement by clicking on the following link

Disclaimer: The views expressed in the above article are solely those of the author/agency in his/her private capacity and do not represent the views of Medical Dialogues.
Source: Self
15 comment(s) on Careless USG report costed doctors Rs 15 lakhs as unethical practice

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  1. user
    Dr Sheo Murti Lal Maurya August 30, 2016, 11:26 pm

    It is difficult to detect all anomalies at every stage of gestation.
    1. Best time is to see anomaly is around 18-20 wks though 14 wks is advised for now a days.
    2. Reason of missing fetal anomaly is that we do only fetal biometry ,rest report is typed by default in every report.
    3. At 20 wks. fetus is almost seen in full veiw by convex probe.
    4. Common and major anomalies are in skull( Anencephaly) and spine. Apart from biometry we should put little care to see ventricles and meningocele.. Give one sweep for whole length of spine with liitle care at LS region because that is most common place for anomaly. Transverse sweep will show 3 dots and intact skin over spine. Even some defect in curvature of spine will attract your attention.
    5. To see kidney is not part of \”fetal wellbeing\” examination.But if you find oligohydramnios try to see kidneys and urinary bladder.
    6. Limbs are very easily seen at this age of gestation but in routine nobody cares to see them as missing limb is very rare.
    7.It sounds nice that at 32 wks of age we should clearly see all the things but in practice it becomes little difficult as size of fetus is large and is demands more time to cover larger surface of abdomen to see fetal details.
    8. In my opinion burden lies more on sonologist who did scan at 20 wks as oligohydramnios further restricts the vision.
    9.If you practice as above in routine at 20 wks. it will require only half of a minute extra but it will save you from further trouble.
    So at around 18- 20 wks be more vigilant. You and pregnant lady both will be benefited as she will have option to discontinue the pregnancy more comfortably if some anomaly is detected which is not compatible to life.
    You can not save yourself by saying that fetus was not in proper position until you put it in black and whites in your report.
    10. If mother is obese or having spinal defect which restricts the visibility write it in report invariably .
    I shall be happy to reply any quarry

  2. Missing an anomaly in routine USG. .not in TIFFA…and at 32week scan with severe oligohydramnios
    does really a utter negligence. … definitely not…every procedure has its limitations. .
    I feel there is difference between pure negligence and a mistake in routine day to day work
    Patient point of view..definitely feel sorry about the loss..
    But there should be a rationale between the amount charging ..and for the mistakes ..
    Is govt. is paying in millions for every human loss which occur due to any kind of negligence. ..

  3. user
    Dr Kusuma Kumar K August 17, 2016, 10:40 am

    How much would have the doctor earned on the case……
    May be 150 or 200 rupees. …..
    Better not to do antenatal scans than getting in to trouble….

  4. user
    Dr.A.K.Agnihotri August 16, 2016, 10:16 pm

    All Doctoots are not brilliant or 100,% competent . they can also make mistake even with maximum efforts. In other profession people can get away by making such mistake.but not poor doctots.

  5. Dr Agnihotri
    If the sonologist has not seen the normAl anatomy then he should have entered in the report an inadequate scan and should have given a reappointment and not hide behind textbooks. I am an orthopaedician and after more than a decade of practice I have never felt ashamed to admit to the patient about my inability to make a diagnosis and always have rescheduled the appointment. If I am still unsure I always give a DD and ask them to review at a later date during which I discuss with my colleagues or refer literature and guide my patients accordingly. At least my conscience is clear and I am sure I have not harmed the patient. What tell concerned doc has done is made a mistake and not owning it and passING the buck .

  6. Dear Doctor
    I do not opine that the radiologist at 20 weeks was not at fault but we should also understand that ultrasound too like other modalities have its limitations. Imaging interpretation and clinical practice cannot be compared and there is no question of conscience over here.
    And in 32 weeks with oligohydraminos, it is practically very difficult to comment on the fetal anomalies.

  7. Yyou should not comment about finding which are not clear. Rather mention doubtful finding.