"MD Medicine Dr. fined Rs.41 lakh for doing pleural tapping test without Sonography, that too in Causality section
"MD Medicine Dr. fined Rs.41 lakh for doing pleural tapping test without Sonography, that too in Causality section "
The Maharashtra State Consumer Disputes Redressal Commission, (MSCDRC) in its recent judgment dated 31/03/2017, gave the verdict against the Doctor, but absolved the Hospital..
Case details - Mr.Prashant Tamhane V/s. P.D. hinduja Hospital and anr. CC No.221 of 2003.
Facts in short :
1. This is the case of 2002. The wife (since deceased) of the Complainant was admitted in the Hospital after the blood reports revealed symptoms of hepatitis. There she was examined by Dr.Ashit Hegde, the Opponent no.2 Doctor in the present case. At that time he after examining the patient he thought it fit for not admitting the patient. By taking medication she was improving.
2.However after about one month, she had Chest pain and difficulty in breathing. Initial X-ray was normal, but in later X-ray, she was diagnosed as suffering from pleural effusion.
3. On next day pleural tapping test was conducted by Dr. Hegde in the Casualty ward and the Doctor left. But as the patient complained of giddiness, Doctor was summoned again, but unfortunately she started sinking.
4.The Doctor tacitly admitted that it could have happened due to puncturing of the spleen by needle during tapping.
5. the CT scanning also revealed that the needle had punctured the spleen resulting in spleenic tear and profuse bleeding internally and she took her last breath in the next morning.
6. Thus the Complaint for medical negligence was filed by her Husband for claiming .Rs.87,50,000/-.
Defense :
1. Dr. Hegde refuted all the charges of Negligence. The patient having complex condition with jaundice, alcoholic hepatitis, liver ailment etc..have lesser chances of surviving. the hospital also denied all the charges against it and submitted that as per Post Mortem report, There were multiple Abscesses in the Brain and the Kidneys and generalized septicemia this contributed to the death of the Patient.
2. It was also argued that the Dr. Hegde is well qualified M.D. (Internal Medicine) passed in 1984. Rather the patient was reluctant to get admitted herself.
Held :
1. The Commission after hearing of parties and perusing the record and going through the various case laws on the point of Negligence of Apex Court, reduced the compensation from Rs.87,50,000/-.to Rs.41,00,000/-.
2.The Commission observed, The courts and the Consumer Fora are not experts in medical science, and must not substitute their own views over that of specialists.
3. It further observed, the entire medical fraternity cannot be blamed or branded as lacking in integrity or competence just because of some bad apples.
4.the Commission raised the query as to why the Process of injecting a needle or puncturing twice of space below chest for Pleural effusion was done casually in the casualty section of the Hinduja Hospital and not in ICU ? Why Sonography was not performed while passing or inserting the needle?
5. This omission on Dr.Hegde’s part is personally blameworthy and punctured Spleen of the Patient did hasten the dizziness, breathlessness and death of the Patient. These facts called for the attraction of well known principle of law i.e. res ipsa loquitur i.e. things speak for itself, and thus No expert opinion was required.
6. The Commission reiterated the "mistake" on part of the Doctor of performing the procedure in casualty section turned to be fatal.
7. Not using Sonography while inserting the needle twice in a case of pleural effusion resulted in puncturing of the spleen which hastened death of Patient.
8. The Commission, in my humble opinion rescued off the Hospital from any liability, as generally Hospitals are held vicariously liable for the Acts of its empanelled Doctors.
How the compensation was ascertained ?
9. Calling claim of Rs.87,50,000/- as exaggerated & exorbitant, it was also observed that Compensation cannot be a lottery or jackpot for a Patient. As the patient when she died was only 35 years of age and her net annual income was computed to the tune of Rs.4 lakhs and applying the multiplier of 10 (this method is used in motor Accident cases, wherein the formula in simple words can be stated as lesser the age, higher the multiplier.
The net annual income X multiplier = compensation. Apex Court in the landmark case of Sarla Verma V/s. Delhi Transport Cor. (2009) 6 SCC 121, has given the table of multiplier), the compensation was calculated at Rs.40,00,000/- and towards Hospital bill and litigation cost, Rs.1 lakh and Rs.25,000/- were awarded respectively, totaling to Rs.41,25,000/-.
This judgment has released shock waves amongst the medical Fraternity. 2 principles which are usually followed, seems not to have been adhered to i.e. 1) Expert Opinion was not called for and, 2) The Hospital was not held liable much less vicariously liable. I am open to correction, but the Multiplier method was not followed by Hon. Apex Court in its landmark judgment of Dr. Kunal Saha’s case.
Moreover, this case is of 2002 and the technology prevailing at that time and as on today might be different and might also be flawless. Some of the medicos are of the Opinion that USG Guided Cannulations and procedures were mandated by NHS since 2006 or 2008 or thereabout, so can it applied to the case of 2002 ?
It's quite likely that this judgement will be challenged in upper forum, so just check for it...Moreover it's applicability as a precedent is restricted to Maharashtra State only and that too as per the facts of each case...
Henceforth, the Doctors will have to rethink as to what procedures are to be performed in Casualty section and what not ? and the question still remains, if the procedure is performed in ICU, whether it can lessen the chances of mortality or still it depend upon the facts of each case ?
Thanks and Regards,
Adv. Rohit Erande
Pune. ©
That internal medicine doctor is not at all at fault. For every minute and trivial procedure one can not dash to an i.c.u. or an operation theatre. In fact ,procedures like pleural tapping, lumbar puncture used to be done in wards, casualty and at homes of patients, if an urgent procedure warranted this. A responsible doctor can not compell the patient to undergo all sorts of investigations like scan etc even before performing simple therapeutic procedures. Tomoro some judge may complain that " this doctor did not do m.r.i.brain scan " even for simple and trivial cold Headache. Rules and laws should be utilised and construed for the benefit of society at large in a broader sense. Are our patients willing to undergo whole body scan , blood tests of all sorts even to treat common cold ? Judgements which mentally and financially torture doctors will make the latter to resort to defensive practice. The colloquial doctor patient relationship of trust and belief, needs to be restored. Then only ,doctors can practise. Otherwise the society will be doomed. NO DOCTOR INTENTIONALLY HARMS ANY PATIENT. Let good sense and wisdom prevail. Amen !
ReplyDeleteDr vinod kulkarni,
M.d.( bom), dpm ( bom) fips, LL.B.
psychiatrist/ Advocate/ social activist/ P.I.L. FILER.
MOB 9844089068
I agree with your view points.
DeleteReciprocate your feelings..
ReplyDeleteWe have to look at the patient s factor, overall reflectance for even admission to hospital, available technology in 2002. Also look at the data of similar procedure happenings in standard medical institutions ( What was standard of care in India or if Indian Data not available then in outside India)
Yes good sense and justice may prevail...
Dr Ashish Soneji
MD IDCCM
CRIRICARE SPECIALIST
Pcpndt laws make availability of USg machines in Iccu or casualty very difficult.
DeleteThis law indirectly made health services expensive. Now it's the time that Every doctor must consider d pt as a future litigant n charge them accordingly. One bad case in a whole life n your whole life earnings r lost.
ReplyDeleteMany of us earn peanuts for the risks we take.
Delete