Failure to refer a patient to Higher Center is Negligence and costed a Doctor Rs.4 lakhs.

Case details :

Dr. Ashok Pachori, Agra V/s. R.K .Tripathi

Appeal No.83/2008 &  295/2008.     Decided on 03/01/2018

Before : Hon. Dr. S.M. Kantikar, Presiding member.

Judgment Links :

http://cms.nic.in/ncdrcusersWeb/GetJudgement.do?method=GetJudgement&caseidin=0%2F0%2FFA%2F295%2F2008&dtofhearing=2018-01-03

http://cms.nic.in/ncdrcusersWeb/GetJudgement.do?method=GetJudgement&caseidin=0%2F0%2FFA%2F83%2F2008&dtofhearing=2018-01-03

Facts in Short :

1. In the month of October-1999, the Complainant Mr. R.K. Tripathi,  A Sub-Inspector, suffered brutal right eye injury due to a bamboo stick and his eye lens got dislocated. The Opponent Doctor Mr. Pachori operated on the right eye, however after removal of bandage the patient had persistent pains.

2. Prior to the injury, in the month of Jan-1999, after getting eyes checking done in another Hospital, the Compliant was told that his right eye lens is dislocated and it requires removal and insertion of new lens. Finally he approached Dr. Ashok Pachori who assured the patient that if the immediate surgery is done, his right will be alright and the new lens will be replaced. On 21/12/1999 the operation was done, but the pains were persistent even after 4-5 days. 

3. During follow-up also the patient complained of pains and no vision, but the Doctor assured that he has removed the dislocated lens and everything will be alright. Finally the patient went to another Doctor in Allahabad, where he was told that without removing the injured lens, the Opponent Doctor implanted new lens and therefore implantation of IOL was not at appropriate place & further  there was retinal detachment also. Finally patient went to Chennai at Sankara Netralaya and got himself operated.

4. Thus he filed a case of Negligence in UP Consumer Forum against Dr. Ashok Pachori on the ground that he implanted ACIOL without removing the injured lens and it resulted into retinal detachment and he lost his vision.

5. The Doctor denied all the charges of negligence and submitted that he examined the complainant and found that there was a posterior sub luxation of lens in the right eye due to blunt trauma. The lens was dislocated laterally and inferiority, also there was vitreous herniating in anterior chamber. Hence, he had planned for Intra Capsular Cataract Extraction (ICCE) on 21-12-1999 with A.C. Intra Occular Lens (IOL). The Doctor further submitted that he has tried to remove overlying vitreous with cellulose spunge, but it was not possible. Also anterior vitrectomy was done removing it by doing all these lens dipped into vitreous, as Zonules were very weak. However, papillary area was clear. He has performed to remove vitreous from anterior chamber and to ensure clear and better vision ACIOL was implanted. The same was informed to the complainant and was asked to come for regular follow up, but complainant never came after 22-12-1999 for follow up treatment or checkup.

6. The State Commission allowed the complaint and ordered the Doctor to pay Rs.4 lakhs.

7. However the Doctor approached the National Commission for suspension of order and the Complainant approached for enhancement of compensation.

Held :

1. The National Commission after perusing the medical record and hearing the arguments, observed that all the Doctors whom the patient approached advised him to remove the lens and further treatment to be taken by implantation of IOL.

2. It was observed that the Doctor made conscious efforts to take out the lens from vitreous but it was failed. The Doctor had tried to extract the lens by means of cryoprop, but it was not freezing the upper pole of lens but overlying vitreous starting freezing. But despite all these procedures the lens dipped into vitreous as zonules were very weak. Therefore, the Doctor performed anterior vitrectomy and removed the vitreous from anterior chamber and, thereafter, ACIOL was implanted.

3. It was lastly observed that as per medical literature without extraction of subluxated lens the IOL implantation is contraindicated. The Doctor would have sent the patient to the higher center or any retina specialist for further management but he failed to refer the patient. Therefore, the Doctor was held to be deficient in his services and negligent. However the Commission rejected the petition of Complainant filed for enhancement of compensation.

4. The case in hand goes back to almost 20 years back. Now the treatment techniques must have changed tremendously. Nevertheless the message is clear, In case of doubt refer the patient to higher center. The Diagnosis Practice is now changing. Doctors do not solely rely on clinical diagnosis.
We can only say - कालाय  तस्मै नमः 
Good news is that, the Commission previously also has held that referring a patient to higher center is not a  negligence. Please see the following link :

http://advrohiterande.blogspot.in/2017/04/referring-patient-to-higher-center-is.html

Thanks and Regards,

Adv. Rohit Erande
Pune. ©