The conduct of a Treating Doctor Conduct fell below that of a reasonably competent doctor, Rs.4.75 lakhs saddled as compensation.

ERCP preferred over MRCP - Landed Doctors in trouble..

Case Details :

M/s. St. Stephen’s Hospital,  Delhi. V/s.  Masood Zafar

Case No. F.A.No.65/2006, Decided on 08/05/2018

Before :

N P KAUSHIK (Member - Judicial)

Link :

http://cms.nic.in/ncdrcusersWeb/GetJudgement.do?method=GetJudgement&caseidin=8%2F0%2FFA%2F65%2F2006&dtofhearing=2018-05-08

Facts in Short :

1. The case goes back to January-2000. The Respondent-Complainant Mr. Zafar took his ailing mother to the Appellant Hospital as she was suffering from severe headache. However the MRI Scan did not show any abnormality. After 4 days, she was again hospitalized for severe abdominal pain.

2. A tentative diagnosis of cholecystitis (gall bladder disease) was made.  Ultrasound revealed biliary sludge with mild biliary dilation and showed a stone in the common bile duct. As per the advise of Dr. Lahoti, the Gastroenterologist  ERCP procedure were performed on 24.01.2000. But the  Patient immediately thereafter developed acute pancreatitis.  On examination, it was found that pus was being informed in the stomach.  

3. The Complainant alleged that it was due to excess quantity of laser beams thrown on the gall bladder during ERCP.  Condition of the patient worsen day by day and ultimately she died on 08/03/2000 in the Hospital.

4. Hence the Complainant, the Son of the deceased filed a complaint in District Forum. The Doctors resisted the claim. They contended that pancreatitis was a known complication of ERCP and was not a result of use of laser and  its decision to perform ERCP could not be faulted. Moreover there was no leaser machine at that time with the Hospital.

5. The Ld. District Forum allowed the compliant and directed the Opponent Hospital to pay Rs.1 lakh. The Ld. District Forum observed that the documents relating to ERCP suggested that one of the risk factors of ERCP was ‘inexperience of the operator’ and further held that the opponent was ‘negligent’ in that during the procedure, ducts had been injured.  Pus was being formed.  Pancreatitis occurred. Hence the Appeal was filed by the Hospital.

Held :

1. The Delhi State Commission rejected the appeal. During pendency of the appeal, the Expert Committee opinion was sought from the Dean M.A.M.C. (Maulana Azad Medical College).

2. The Expert Committee did not find the Doctors Negligent. It was also observed that the pancreatitis was a well known and unpredictable complication of ERCP and in the given case there was no use of leaser as alleged. However it was observed that  MRCP should have been preferred over ERCP since the USG abdomen report was not definitive for the presence of CBD calculi, to document the present of CBD calculi before proceeding for the ERCP procedure.  Had this been done, this ERCP and its subsequent complication could have been avoided.

3. The Commission relying upon the Expert opinion further observed that treating doctors were simply having a suspicion of stone being present in the bile duct.  In such a situation, doctor with a reasonable knowledge and a reasonable commonsense would have resorted to MRCP.  No material has been placed on record by the  Hospital that on the basis of mere suspicion of presence of CBD calculi, one should jump to ERCP which is having risk of complications.Treating doctors were in a hurry to perform ERCP over MRCP.  Conduct of the treating doctors thus fell below that of a reasonably competent doctor.   It is not a case of difference of opinion or error of judgement.

4. The Commission enhanced the Compensation to the tune of of Rs.4,75,000/- plus interest @ 12% p.a. from March 2000, till its realization. For calculating the compensation it relied upon various judgments of Apex Court.  It relied upon the judgment of Hon. Supreme Court in the case of Nizam Institute of Medical Sciences vs. Prasanth S. Dhananka and Others, 2009 (2) CPJ 61 (SC), wherein the Supreme Court cautioned holding thus:

“… the court has to strike a balance between the inflated and unreadable demands of a victim and the equally untenable claim of the opposite party saying that nothing is payable.  Sympathy for the victim does not, and should not, come in the way of making a correct assessment, but if a case is made out, the court must not be chary of awarding adequate compensation.  The ‘adequate compensation’ that we speak of, must to some extent, be a rule of thumb measure, and as a balance has to be struck, it would be difficult to satisfy all the parties concerned.”

The Judgment is based on the facts of the case which occurred in the year 2000. Now after lapse of 18 years, there must have been great change in Medical Science including procedures like ERCP / MRCP. Nevertheless this case tries to throe light upon the thin line of difference between mere error of judgment and conduct of treating Doctor felling below that of a reasonably skilled Doctor.

Well, this is a state commission judgment and may come under scanner of Nationsl Commission and lastly of Hon. Supreme Court, if it's challenged.

Thanks and regards

Adv. Rohit Erande.

Pune. ©