Medical Negligence in Post-Operative Care: Supreme Court slaps compensation on Eye Surgeon
Supreme Court of India
New Delhi: The Supreme Court bench recently directed a Maharashtra-based eye surgeon to pay Rs 3.5 lakh compensation to a patient, who developed an infection and abscess after undergoing a cataract surgery around 25 years ago.
Even though the State Consumer Court had asked the doctor to pay compensation, the National Consumer Disputes Redressal Commission (NCDRC) had held that there was no negligence on the doctor's part.
However, while considering the matter, the Apex Court bench upheld the State Commission's findings that the eye-surgeon had failed to diagnose and take corrective steps after the patient developed the infection post-surgery.
Setting aside the NCDRC order, the top court bench comprising Justices Vikram Nath and PB Varale held, "It was a blatant result of medical negligence by the respondent in post-operative care wherein corrective steps could have been taken, if the most reasonable and basic skills which were expected from the respondent-doctor, were applied."
"Accordingly, the appeals are allowed. The impugned order is set aside and the respondent is directed to pay compensation of Rs. 3,50,000/- (Rupees Three lakh fifty thousand only) to the appellants within a period of 2 months, failing which the amount shall carry an interest @12% per annum from the date of judgment till its realization," ordered the Court.
Also Read: HC sets aside NCDRC order imposing Rs 93 lakh compensation on doctor
The history of the case goes back to 1999 when the complainant/patient, a resident of Lonavala, had developed cataract in his right eye and had approached the treating eye surgeon at his clinic in Pune. After examining the patient, the surgeon had advised for an operation for the removal of the cataract in the right eye.
Accordingly, the cataract surgery was performed by the surgeon on 19.01.1999 in Sushrut Hospital and the patient was discharged on the same night itself. However, the next day, the patient developed severe pain in the operated eye along with a headache. When he approached the treating doctor, the latter changed the bandage of the operated eye, prescribed medicines along with eye drops and gave him to wear black glasses.
The appellant was called back again on 23.01.1999 for follow up, during which, the patient complained of intense pain in his operated eye. When the doctor removed the bandage and examined the right eye, the appellant could not even open his eye because of sticky fluid oozing out of his eye. The doctor replaced the bandage again and allegedly assured the patient that the surgery was successful. He had also prescribed certain painkillers and eye drops. Apart from this, the patient had been allegedly assured that his pain would subside and vision would be restored.
However, the condition worsened and the pain became unbearable. During the follow-up on 27.01.1999, the patient complained that he was unable to see anything. Despite this, the doctor allegedly kept assuring that the vision would be restored to normal in a few days. Blood sugar test was recommended and the reports were normal.
Since the condition did not improve, the patient contacted one Dr. Tasliwal, an eye surgeon from Yerawada, who further referred the patient to another eye specialist named Dr. Khare. After checking the patient, Dr. Khare opined that the operated eye was completely damaged and if not removed in time, it may lead to further damage to the brain. A third opinion was sought from an eye specialist from Pune, who also opined that there was a septic infection in the operated eye and it needed to be removed.
Thereafter, the appellant, along with his relatives, ran from post to pillar for surgical removal of the infected eye and was finally admitted at the Military Hospital at Wanawadi, where he was diagnosed with endophthalmitis. Thereafter, an operation was performed for removal of partially extruded IOL through limbal section. As a result, doctors from military hospital succeeded in retaining the eyeball for cosmetic purposes but the appellant lost his complete vision from the right eye.
Aggrieved by the loss of vision, money spent on doctor visits and operation and the hardship caused in the entire series of unfortunate events, the complainant demanded a compensation of Rs 10 lakh from the doctor and consequently filed a complaint before the District Consumer Forum contending medical negligence and praying for Rs 3.5 lakh compensation for loss of vision along with special damages and interest on the amount.
However, noting that the complainant had not filed any expert evidence or affidavit of the doctors of the Millitary Hospital, the District Consumer Court dismissed the complaint in 2005. This was challenged before the State Consumer Court. During the proceedings, the complainant's counsel submitted the opinion of an ophthalmologist.
Following this, the State Commission in 2015 partly allowed the appeal observing that the doctor had filed his reply without any case papers. Further, the State Commission noted that though the case papers were prepared after filing of the written version, there were contradictions in the written version and the alleged original case papers as there was no entry of trauma which is alleged in the written version by the authorities.
Apart from this, the State Commission also perused the discharge summary of the complainant provided by the Military Hospital. Ultimately, the State Commission held that the doctor had miserably failed to treat the complainant post-operatively. It was concluded that the complainant had developed infection after the operation of cataract and the doctor miserably failed to diagnose it and take correct steps, which pointed out a clear-cut case of medical negligence on the part of the respondent in post-operative treatment.
Accordingly, the doctor was directed to pay Rs 3.5 lakh compensation within two months, failing which the amount would carry an interest @12% per annum from the date of order.
However, the NCDRC bench set aside the State Commission's order based on the finding that after three days of the surgery, the complainant had approached the doctor with a new dressing and pad which was not put when the complaint was sent back on 20.01.1999 and there was no explanation provided by the complainant as to why and from where he had applied the new pad and dressing.
NCDRC came to the conclusion that the patient had on his own changed the dressing of operated eye which caused the displacement of lens and the infection appears to be traumatic in nature. Therefore, it was held that the development of endophthalmitis was due to traumatic injury and cannot be attributed to any fault or deficiency on the part of the doctor during the cataract surgery.
The NCDRC order was challenged before the Supreme Court bench, which noted that the doctor had not produced any case papers or prescription details to corroborate his written version and it was only at the appellate stage before the State Commission that the doctor produced such case papers for the first time.
"Even then, a bare perusal of prescription dated 23.01.1999 makes no specific mention of any trauma that has been observed by the respondent-doctor on the said date. The said fact has not been taken note of by NCDRC in the impugned order. In these circumstances, no credible reliance can be put on the respondent’s written version which was not supported by enough evidence to discharge him of his liability to exercise due care or to shift the said liability on the appellant. Therefore, in the absence of corroborating documentary proof, the said argument is of no avail to the respondent-doctor," noted the top court bench.
Further, the Supreme Court also perused the medical opinion rendered before the State Commission by an ophthalmologist Dr. Das. "In the said medical opinion, it has been clearly stated that oozing of pus after operation is not a usual occurrence and, in cases where there is small amount of white discharge from the eye post-operation, it usually disappears within 48 hours. It was further opined that oozing of pus after a cataract operation indicates presence of infection in the operated eye which needs to be treated aggressively, both locally and systematically, to prevent further spread of infection. With regard to the diagnosis of endophthalmitis after a cataract surgery, pain in the operated eye and no regaining of vision following operation were considered to be the two most important symptoms – a complaint that was consistently made by the appellant herein in his multiple visits to the respondent post-operation," noted the top court bench.
Holding that the doctor was negligent, the top court bench noted,
"Given the medical opinion reproduced above and the fact that the appellant made five visits to the respondent-doctor in a week’s period while consistently complaining of immense pain in the operated eye, headache and lack of vision while the respondent kept reassuring him that the operation was successful and he would recover his vision eventually, whereas all the three other doctors who the appellant visited on 27.01.1999 opined that the appellant was suffering from endophthalmitis which has led to complete damage of the eye, it becomes evident that the respondent-doctor was negligent in his diagnosing the respondent’s eye."
"It becomes clear that the respondent failed to detect the infection and clear the same in time despite several complaints by the appellant. The said infection was diagnosed by the three doctors, namely Dr. Chitra Khare, Dr. Nitin Prabhudesai and doctors at the Military Hospital, but it was too late by then and the appellant had to undergo evisceration of his right eye leading to loss of vision. It was a blatant result of medical negligence by the respondent in post-operative care wherein corrective steps could have been taken, if the most reasonable and basic skills which were expected from the respondent-doctor, were applied," it further observed while restoring the order of the State Commission.
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/supreme-court-medical-negligence-267170.pdf
