Emergency treatment as per protocol : Rs.50 lakh claim dismissed against Doctors

Complications in Cataract Surgery : "Doctors were saved from paying Rs.50 lakhs, as they performed their duties in emergency as per protocol" 

Case Details :
MRS.KAILASH MALHOTRA V/s. CENTRE FOR SIGHT (HOSPITAL) & ANR, NEW DELHI
FIRST APPEAL NO. 410 OF 2015, decided on  17 Jul 2017. 
See the following link :
http://cms.nic.in/ncdrcusersWeb/GetJudgement.do?method=GetJudgement&caseidin=0%2F0%2FFA%2F410%2F2015&dtofhearing=2017-07-17

Facts in short :

1. Mrs. Kailash Malhotra,  78 years old, heavy diabetic, was operated as advised on her left eye for cataract. However it was alleged by the Complainant that  the surgery was performed hurriedly  and negligently and as even after more than three weeks, her vision did not adequately regain, she went to Safdarjung Hospital, where  it was revealed that the procedure was not properly performed .

2. She was advised for 2nd surgery, but she had no faith in the opponents and she approached Army Hospital (R & R), wherein an attempt was made to salvage her left eye, but in vain.. Hence she fled a complaint with State Commission for getting compensation of Rs.50 lakhs.. 

3. The Doctors  and the Hospital opposed the complaint and it was pleaded on their behalf that the complainant, with heavy diabetics, had high degree of loss of vision, both eyes showed Cataract with nuclear sclerosis., and the patient had hard dense brown cataract in the left eye; with poor pupillary dilation.

4. Her right eye operation was successful. However despite due care and caution during surgical procedure, the Posterior Capsular Rupture (PCR) occurred ( a known complication in cataract surgery).  Therefore, after taking necessary consent, the treatment necessary at that point of time was anterior vitrectomy with Anterior Chamber Intraocular Lens Implantation ( ACIOL), was performed.

5. The matter was sent for an expert opinion from Medical Board of Guru Nanak Eye Centre at New Delhi. After hearing of the parties and on the basis of expert opinion, the Complaint was dismissed. Hence the Appeal.

Held :

1. The National Commission also dismissed the compliant after perusing the medical record and expert opinion.

2. It was observed by the Commission that , the complainant visited the OPs on 16.09.2006.on examination  the Doctor diagnosed it as raised IOP and non-resolving vitreous hemorrhage. Thus, he advised the complainant to undergo Pars Plana Vitrectomy  with Guarded Visual prognosis.  It was the standard protocol for management of non-resolving vitreous hemorrhage with high IOP. The complainant again delayed the treatment for 18 days as advised by OP-2. Instead of that, she consulted the Army Hospital    ( RR) at Delhi Cantt. who advised her more extensive surgery. At R R Hospital, she underwent Modulated Trabeculectomy + ACIOL Explanation +Vitrectomy. The Scleral Fixated Lens implantation was performed.  Even notes of Army Hospital do not suggest any destruction of her left eye.   Thus, it was observed that , same cannot by any stretch of imagination be considered negligence by the Doctor.

3. It relied on the celebrated judgments of Hon. Apex Court in the case of .Kusum Sharma Vs. Batra Hospital (2010) 3 SCC 480, it was laid down that, "Negligence cannot be attributed to a doctor so long as he performs his duties with a reasonable skill and competence. Merely because the doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chosen by him was acceptable to the Medical Profession."

4. It also relied upon Dr. Laxman Balkrishna Joshi vs. Dr. Trimbark Babu Godbole and Anr., AIR 1969 SC 128 and A.S.Mittal v. State of U.P., AIR 1989 SC 1570, wherein  certain duties of doctor  were laid down :

                        (a) duty of care in deciding whether to undertake the case, 

                        (b) duty of care in deciding what treatment to give, and 

                         (c) duty of care in the administration of that treatment.

A breach of any of the above duties may give a cause of action for negligence and the patient may on that basis recover damages from his doctor.

5. Thus on the above grounds, judgments and material it was held that the PCR is the known complication in cataract surgery and moreover it was properly managed and there was no breach of duty on part of doctors.

It's a very important judgment. Certainly it's unfortunate for that lady to lose her eye vision. But Human body is a complex machine and anything can happen in spite of due care and precaution in the treatment,. So long as Doctors perform thier duties as per Standard protocol and as per thier skills, Doctors  cannot be held negligent for simply because things went wrong from mischance or misadventure. In this case also the treatment was proper and most importantly, the "informed consent" was  also properly taken. 

Thanks and Regards

(Adv. Rohit Erande)

Pune. ©