Failure to diagnose Urinary Stones by USG does not amount to Medical Negligence, as the sensitivity and specificity of USG varies. Adv. ROHiT ERANDE. ©

Failure to diagnose Urinary Stones by USG does not amount to Medical Negligence, as the sensitivity and specificity of USG varies. 

Positive beginning of the year for Doctors.. 

Adv. ROHiT ERANDE.©

Case Details : 

 Before NCDRC. REVISION PETITION NO. 266 OF 2019

DAYA SINGH   V/s.   SHIVI DIGITAL X-RAY, ULTRASOUND, COLOUR DOPPLER AND MAMMOGRAPHY CENTRE & 3 ORS.

BEFORE:  

  HON'BLE DR. S.M. KANTIKAR,PRESIDING MEMBER

  HON'BLE MR. BINOY KUMAR,MEMBER

Facts in Short :

1.       The Petitioner  filed the  revision petition  against the Order dated 26.11.2018 passed by the State Consumer Disputes Redressal Commission, Haryana, Panchkula (for short the ‘State Commission’) in Appeal No. 434 of 2018, wherein the State Commission, which dismissed the Appeal filed by the Petitioner.

2.       The question involved herein is that whether failure to diagnose the urinary stone by Ultrasonography (USG) constitutes medical negligence?

3.     It is the case of the complainant that  On or about 31.08.2015  he suffered severe abdominal pain, and on his own got done an ultrasound from the Opponent no.1- Shivi Digital X-Ray Ultrasound Coloured Doppler Mamography Centre . 

4. The USG was reported as no calculus (stone), and there was no problem in the kidneys. However, as he was getting regular abdominal pain, on 08.09.2015 he got 2nd USG  done which revealed 17 mm Calculus in the Renal Pelvis and 5-6 small Calculi. 

5. Thereafter, Dr. Sudhir Kapoor operated him and the stones were removed in Kapoor Hospital at Ambala. Being aggrieved by negligence of the Opp. No. 1 who failed to diagnose renal stone, which incurred heavy expenses and physical and mental agony, the Complainant filed a complaint before the District Forum, Ambala.

6.       The District Forum,  held that it was not negligence; because of certain technical limitations during USG examination. The Complaint was dismissed. Being aggrieved by the Order of District Forum, the Complainant filed a First Appeal No. 434/2018, before the State Commission, Haryana at Panchkula. It was dismissed with the following observation:

    “7.    In first report of ultrasound, the presence of stone was not     detected. However, in the second report the stone was deducted and thereafter, relying upon the second report, the surgery was conducted and the stone was removed. Somehow, if the presence of the stone was not reflected in the first report, it cannot be considered to be medical negligence. It may be due to some technical deficiency of particular equipment, which is used for preparing the report or conducting the test. The learned District Forum has taken into consideration each and every aspect from every angle. There is no illegality or ambiguity in the impugned order. Resultantly appeal fails and the same is hereby dismissed.”

Being aggrieved, the Complainant filed the instant Revision Petition.

Held :

1. After hearing of the parties at length and going through the documents and medical literature on record, the NCDRC also dismissed the Revision Petition filed by the Complainant -petitioner. 

2. It was observed that the 1st USG was done by  Dr. Subhash Goel (MD Radiology) - the Opposite Party No. 1, who is a qualified Radiologist. He reported in USG that size and shape of both the kidneys were normal, and no evidence of stone or hydro-nephrosis. A simple left renal cortical cyst was reported, which was insignificant. But After about a week on 08.09.2015, the Complainant got another USG performed by Radiologist Dr. Manish Agrawal at Agrawal X-ray and Scan Centre, it revealed 17 mm stone and a left renal cyst with evidence of hydronephrosis.

3. On the difference in reports,    on perusal of both the reports a doubt was in our mind that some discrepancies are evident in both the USG reports. In the first USG report, the age of the patient was mentioned as 58y, whereas the second ultrasound it was   67yrs. As stated by the Complainant, he was operated by Dr. Sudhir Kapoor for the removal of stone. However, there is nothing on record to prove that the patient was same Daya Singh. The Complainant neither filed the treatment record nor any affidavit of Kapoor Hospital to prove his case. The operative details or the size and type of the stones removed were not available. 

4. the Ld. Commission went through  few medical literature on the USG diagnosis of urinary calculi viz. “Accuracy of ultrasound versus computed tomography urogram in detecting urinary tract calculi”[1] ; “Diagnostic Accuracy of Ultrasound & X-ray KUB in Ureteric Colic taking CT as Gold Standard”[2]; “Accuracy of ultrasonography for renal stone detection and size determination: is it good enough for management decisions?[3]. 

5. It was held that as per the medical literature, the USG had limited role in detection of renal calculi. It is an accessible and inexpensive imaging method without the risk of exposure to ionising radiation during CT study. In several studies, the accuracy of detecting renal, ureteric and urinary bladder calculi are 67%, 80% and 98% respectively. The sensitivity and specificity of USG varies. The calculi may be missed during USG due to lack of acoustic shadowing of the calculus, therefore, false positive or false negative detection is possible, therefore, sometimes calculi not being identified on USG. Very often detection of translucent stones is missed during USG done by the experienced hands.

6. Lastly it was held both the lower forums decided correctly and  that  the instant case was neither wrong diagnosis or missed diagnosis. Both the Radiologists were qualified and performed the USG as per the reasonable standards. The medical negligence is not conclusively attributed upon the Opposite Party No. 1.

Very important ruling to at the beginning of the new year. Kidney stones is the common problem faced by many and treated regularly. The USG is the basic diagnostic treatment after Urine and blood patholgoical reports. IF that also is not fruitful, then CT scans are advised. However, as observed in the instant case, some stones are so small that may not come in USG. Further, why would a Doctor give a false report even if he/she finds out the kidney stones while doing USG ? No doubt the patient must have suffered  great deal of pain, but same alone cannot be the sole basis of alleging medical negligence. Of course, this judgment does not mean that Doctors are saved forever from any such diagnostic. Facts and documents of each case cant be the game changer. 

With kind regards

(Adv. Rohit Erande)©