Rs. 5 Crore case dismissed as Doctors followed the Standard Protocols of Treatment.

 A case claiming Rs. 5 Crores (!) dismissed, as Doctors followed the Standard Protocols of Treatment. 


Case Details :

Abdul Shaik V/s.Dr. Vikram Mathews, Christian Medial College, TN.

CC No.194/2009.

Before :

Dr. S.M.Kantikar (presiding Member)

Judgment Link :

http://cms.nic.in/ncdrcusersWeb/GetJudgement.do?method=GetJudgement&caseidin=0%2F0%2FCC%2F194%2F2009&dtofhearing=2018-03-19

Facts in short :

1. Mulla Abdul, the patient, was admitted to Christian Medical College (CMC) in June-2007 for further management of  Mylodisplastic Syndrome (MDS) from Vellore. It was alleged that without concrete diagnosis, the patient was shifted to Cancer ward and was put under heavy treatment of powerful injections and it lea to serious side effects like swelling of his both legs, below waist, both ankles and in both wrists. However there was no treatment given.

2. The Doctors could not diagnosis and suspected TB also. His sputum sample was sent for diagnosis. After Bone Marrow Biopsy it was  diagnosed as Refractory Anemia with Cancer Blast (RAEB, Type II). The Oppoent Doctor, the Hematologist,  suggested for Bone Marrow Transplant (BMT) as the best possible remedy. It was contended that the Doctors did not explain the side effects of the same, but only told the expenses to the tune of Rs.10 lakhs and in complications it might go upto Rs.20 lakhs. The Complainant herein, i.e. the father of the patient could manage only Rs.6 lakhs. However even after BMT, the swellings could not be cured and doctors did not pay any heed to the requests of treatment. Ultimately he was discharged from the Hospital, even though not fully recovered. After about 2 years, in Jan-2009, the patient had severe pain in left shin. He contacted the same Doctor - Hematologist who inturn asked the patient to go to local Orthopedic Surgeon in Vellore. Accordingly patient went to one Dr. N.V. Shastry. Dr. Shastry informed the patient that the pus had formed in left knee and prescribed antibiotics. However there was no improvement and hence Dr. Shastry referred the patient to a physician Dr. J. Raghunath, who further referred to CMC where he was seen by Orthopedic Surgeon Dr. Kaushik, i.e. the Opponent No.2 in the matter.

3. Dr. Kaushik opined that swelling is harmless and will be subsided in due course of time. It was alleged that the Opponent No.1 Doctor did not advice for MRI or Shine bone biopsy. It was done by yet another Ortho. Surgeon, Dr. Shivreddy. After MRI, Dr. Shivreddy suspected that it was a case of life threatening BMT cancer related to bones. After Biopsy in CMC it was diagnosed as Low Grade Sarcoma without any metastasis in Body. IT was alleged that the Doctor No.1 should have admitted the patient for treatment of Sarcoma. Ultimately the patient succumbed to death in June-2009 and the father-complainant filed case for claiming Rs.5 Crores compensation.

Defense :

1. The Doctors and Hospitals denied all the allegations. All the treatment was given in time and as per Standard Protocol. 

2. It was contended that in the case of MDS-RAEB - Type II,  one can opt to directly proceed for BMT without undergoing chemotherapy. The nature of disease and options of therapy and the side effects etc. were discussed in detail with the patient and his father. On further evaluation, it was noted that he had Human Leucocyte Antigen (HLA matched sibling) which was a need for a successful BMT. Accordingly, allergenic bone marrow transplant was decided, which is an internationally accepted standard of care in such patients. The Hospital contended that it helped  the patient to raise funds from Prime Ministers Fund, Ratan Tata Fund etc. the sum of Rs.5,20,709/- was refunded and the Complainant appreciated this fact by writing letters.. Moreover the BMT was done at C-rates (General Ward rates) as a exceptional case considering the age of patient and financial constraints. 

3. It relied upon the expert opinion Tata Memorial Hospital, Mumbai (TMH) which  opined that the diagnosis and treatment given to the patient was in accordance with prescribed medical protocol.

Held :

1. The Commission relied upon various decisions of Hon. Supreme Court which in nutshell has held that "Medical science has conferred great benefits on mankind, but these benefits are attended by considerable risks. Every surgical operation is attended by risks. We cannot take the benefits without taking risks. Every advancement in technique is also attended by risks....." "It is so easy to be wise after the event and to condemn as negligence that which was only a misadventure. We ought to be on our guard against it, especially in cases against hospitals and doctors.  We cannot take the benefits without taking the risks. Every advance in technique is also attended by risks. Doctors, like the rest of us, have to learn by experience; and experience often teaches in a hard way.."

2. It was observed that the Doctors followed the standard protocol and treated MDS RAEB Type II patient.  It is known fact that only 52% cases suffering from MDS are cured while in majority of cases recurrence is seen. In the instant case, there was a relapse of myeloid leukemia after 14 months of BMT. Therefore, chances of cure with chemotherapy were unlikely, thus, only palliative treatment was suggested. Thus, there was no negligence or deficiency in service on the part of the opponents. It is also proved from the expert opinion from TMH that the treatment given by OP is in accordance with the established medical protocols. The doctors have performed their duties and exercised ordinary degree of care and skill. 

3. Ultimately it dismissed the compliant of Rs.5 Crores. 

Well, this is yet another case where following standard protocols have saved Doctors. Its certainly an irreparable loss for the bereaved father to lose 19 years Son. But yet again we have to understand the limitations of Medical science. 

It reminds me the famous quote of Sir William Osler, the Great Canadian Physical of his times, "Medicine is a science of uncertainty and an art of Probability"

Thanks and Regards

Adv. Rohit Erande

Pune. ©