Advantage Consumer

	advantageconsumer.com Consumer Protection Council, Rourkela

	Important judgements passed by the Consumer Courts There is no medical negligence when there is neither deviation of reasonable practice nor neglect by the doctors NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI CONSUMER CASE NO. 305 OF 2018 ABHISHEK MEENA ........... Complainant(s) Versus ALL INDIA INSTITUTE OF MEDICAL SCIENCES & 2 ORS. ........... Opp. Party(s) BEFORE: HON'BLE MR. DR. S.M. KANTIKAR, PRESIDING MEMBER Dated : 01 Jul 2019 ORDER 1. This complaint of alleged medical negligence filed by Abhishek Meena, the complainant (for short, ‘patient’) against All India Institute of Medical Sciences (for short, ‘AIIMS’) and two treating doctors Dr. Amit Khandelwal and Dr. Nasiq working at Dr. Rajendra Prasad Centre for Ophthalmic Sciences (for short, ‘eye institute’) at New Delhi. The complainant alleged that due to negligent treatment at the eye institute he permanently lost his vision in right eye. 2. Briefly stated the facts are, on 29.06.2017 complainant approached the eye institute for his complaint of blurring of vision in his right eye. After examination and various tests doctors prescribed few medicines including steroid -Wysolone. According to complainant, he had no major problem in his right eye but, it arose only after 01.07.2017. His health deteriorated further due to continuation of medicine ‘Wysolone’ 60 mg resulted severe swelling of face with pimples and also significant loss of weight. He suffered gradual loss of vision in his right eye. On seeing the report of Chest CT scan, the doctors immediately stopped the medicine from 26.07.2017. It was stated that ‘Wysolone’ was not to be given in a patient having tuberculosis. The opposite parties – doctors started ‘‘Wyslone’ 60 mg without confirming tuberculosis. Thus, it was careless and negligent treatment from the opposite parties, which resulted in loss of patient’s vision in right eye forever. Thus, complainant lost all hopes in his life as well as chance of employment. Complainant filed the instant complaint before this Commission for seeking compensation of Rs. 2 crore from the opposite parties. 3. Heard the learned counsel for complainant at admission. Perused the material on the record and given thoughtful consideration. As per medical prescription, on 28.06.2017 the doctors (OP-2 and 3) at eye institute had diagnosed it as a case of Disc Granuloma with imminent Central retinal vein occlusion (CRVO) of right eye. The vision was 6/12 in left eye and 6/12 in right eye. Doctors prescribed ‘Wysolone 60 mg.’ and Pantocid 40 mg. once a day and patient was referred to Pulmonary medicine department on 05.07.2017 to rule out possibility of Tuberculosis or Sarcoidosis. There, the patient was advised few blood investigations viz. hemogram, ESR, Lymes Titre, Weilflex test, Montoux, VDRL, HBsAg, HIV. Also X-ray chest and USG of eye were advised. The patient was prescribed same medicines tab. Wysolone 60 mg once a day and tab. Pantop 40 mg. On the advice of pulmonary medicine department, Chest HRCT scan was performed on 13.07.2017 and the report was made available on 26.07.2017. On seeing the report, the doctors at eye institute stopped the medicine and again advised to consult pulmonary medicine department wherein doctor told him to undergo EBUS and TBNA tests. In the meantime, injection Posterior sub-Tenon injection (PST) 0.5 mg on 29.07.2017 was administered to the patient’s right eye and he was advised to wait for opinion from Pulmonary Department, medicine opinion / clearance for oral steroid. He was given another injection of Intravitreal Avastin on 19.08.2017. From 23.08.2017, the dose of Wysolone 40 mg. once a day was given. Thus, same treatment was confirmed. Patient’s vision tested on 05.08.2017 was 6/12 in the right eye and 6/9 in the left eye. Thereafter doctors prescribed eye drop and informed the patient to wait for the instructions from pulmonary medicine department. Subsequently, on 12.08.2017, his right eye sight became very weak and therefore, doctors at eye institute administered injection Avastin on 14.08.2017 intra-vitrally and patient was called for follow up on 23.08.2017. However, on 17.08.2017, the complainant lost complete vision in right eye and was declared to be a permanent damage without any further treatment. The EBUS –TBNA test done on 28.08.2017 reported as mediastinal lymphadenopathy. Also on the basis of radiological studies patient was diagnosed mediastinal lymphnode necrosis and AFB was positive – thus mediastinal tuberculosis (TB) and accordingly, the patient was started on anti TB medication (DOT). The doctors - opposite parties discontinued the medicines and steroid from 30.08.2017. Thereafter, complainant suffered eye infection but there was no improvement till 16.01.2018. 5. In my view, on the basis of medical record and clinical findings, admittedly eye institute diagnosed it as a case of disc-granuloma in the right eye. I took reference from few articles on disc granuloma and the standard book Parsons' Diseases of the Eye – the disc granuloma was the main cause diminution of vision in the right eye of the patient. The main cause for disc granuloma is either tuberculosis or sarcoidosis. Moreover, the opposite parties i.e. doctors from department of ophthalmology and pulmonary medicine have taken all the efforts to arrive at proper diagnosis and treated the patient as per standard practice. The EBUS test is mainly advised to rule out tuberculosis or sarcoidosis or other pathology in the lungs. The administration of steroid in the TB patient is neither contraindicated nor had any serious adverse effect on the prognosis of disease. It was neither deviation of reasonable practice nor negligence of doctors (OP 2 and 3) at eye institute. The decision to administer intravitral injections PST and Avastin was correct in the case of disc granuloma with CRVO of right eye of the patient. 5. Sarcoidosis and tuberculosis (TB) show epidemiological, immunological, and molecular features common to both, and often, it becomes difficult to differentiate them especially in a highly TB-endemic country like India. The case optic disc granuloma along with mediastinal TB the choice of treatment will be anti-tuberculosis therapy and oral steroids. It should be borne in mind that, ‘no cure is no negligence’. The instant complaint is misconceived and filed by the complainant with the ignorance of medical knowledge. I find here neither any deficiency in service nor any negligence caused to the patient from the treating doctors. The complaint is dismissed at admission stage. Top

There is no medical negligence when there is neither deviation of reasonable practice nor neglect by the doctors

NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION, NEW DELHI

CONSUMER CASE NO. 305 OF 2018

ABHISHEK MEENA ........... Complainant(s)
Versus
ALL INDIA INSTITUTE OF MEDICAL SCIENCES & 2 ORS.
........... Opp. Party(s)

BEFORE:
HON'BLE MR. DR. S.M. KANTIKAR, PRESIDING MEMBER

Dated : 01 Jul 2019

ORDER

1.      This complaint of alleged medical negligence filed by Abhishek Meena, the complainant (for short, ‘patient’) against All India Institute of Medical Sciences (for short, ‘AIIMS’) and two treating doctors Dr. Amit Khandelwal and Dr. Nasiq working at Dr. Rajendra Prasad Centre for Ophthalmic Sciences (for short, ‘eye institute’) at New Delhi. The complainant alleged that due to negligent treatment at the eye institute he permanently lost his vision in right eye.

2.      Briefly stated the facts are, on 29.06.2017 complainant approached the eye institute for his complaint of blurring of vision in his right eye. After examination and various tests doctors prescribed   few medicines including steroid -Wysolone. According to complainant, he had no major problem in his right eye but, it arose only after 01.07.2017. His health deteriorated further due to continuation of medicine ‘Wysolone’ 60 mg resulted   severe swelling of face with pimples and also significant loss of weight. He suffered gradual loss of vision in his right eye. On seeing the report of Chest CT scan, the doctors immediately stopped the medicine from 26.07.2017. It was stated that ‘Wysolone’ was not to be given in a patient having tuberculosis. The opposite parties – doctors started ‘‘Wyslone’ 60 mg without confirming tuberculosis.   Thus, it was careless and negligent treatment from the opposite parties, which resulted in loss of patient’s vision in right eye forever. Thus, complainant lost all hopes in his life as well as chance of employment. Complainant filed the instant complaint before this Commission for seeking compensation of Rs. 2 crore from the opposite parties.

3.      Heard the learned counsel for complainant at admission. Perused the   material on the record and given thoughtful consideration. As per medical prescription, on 28.06.2017 the doctors (OP-2 and 3) at eye institute   had diagnosed it as a case of Disc Granuloma with imminent Central retinal vein occlusion (CRVO) of right eye. The vision was 6/12 in left eye and 6/12 in right eye. Doctors prescribed ‘Wysolone 60 mg.’ and Pantocid 40 mg. once a day and patient was referred to Pulmonary medicine department on 05.07.2017 to rule out possibility of Tuberculosis or Sarcoidosis. There, the patient was advised few blood investigations viz. hemogram, ESR, Lymes Titre, Weilflex test, Montoux, VDRL, HBsAg, HIV. Also X-ray chest and USG of eye were advised. The patient was prescribed same medicines tab. Wysolone 60 mg once a day and tab. Pantop 40 mg. On the advice of pulmonary medicine department, Chest HRCT scan was performed on 13.07.2017 and the report was made available on 26.07.2017. On seeing the report, the doctors at eye institute stopped the medicine and again advised to consult pulmonary medicine department wherein doctor told him to undergo EBUS and TBNA tests. In the meantime, injection Posterior sub-Tenon injection (PST) 0.5 mg on 29.07.2017 was administered to the patient’s right eye and he was advised to wait for opinion from Pulmonary Department, medicine opinion / clearance for oral steroid. He was given another injection of Intravitreal Avastin on 19.08.2017. From 23.08.2017, the dose of Wysolone 40 mg. once a day was given. Thus, same treatment was confirmed.

Patient’s vision tested on 05.08.2017 was 6/12 in the right eye and 6/9 in the left eye. Thereafter   doctors prescribed eye drop and informed the patient to wait for the instructions from pulmonary medicine department. Subsequently, on 12.08.2017, his right eye sight became very weak and therefore, doctors at eye institute administered injection Avastin on 14.08.2017 intra-vitrally and patient was called for follow up on 23.08.2017. However, on 17.08.2017, the complainant lost complete vision in right eye and was declared to be a permanent damage without any further treatment. The EBUS –TBNA test done on 28.08.2017 reported as mediastinal lymphadenopathy. Also on the basis of radiological studies patient was diagnosed mediastinal lymphnode necrosis and AFB was positive – thus mediastinal tuberculosis (TB) and accordingly, the patient was started on anti TB medication (DOT).     The doctors - opposite parties discontinued the medicines and steroid from 30.08.2017. Thereafter, complainant suffered eye infection but there was no improvement till 16.01.2018.

5.     In my view, on the basis of medical record and clinical findings, admittedly eye institute diagnosed it as a case of disc-granuloma in the right eye. I took reference from few articles on disc granuloma and the standard book Parsons' Diseases of the Eye – the disc granuloma was the main cause diminution of vision in the right eye of the patient. The main cause for disc granuloma is either tuberculosis or sarcoidosis. Moreover, the opposite parties i.e. doctors from department of ophthalmology and pulmonary medicine have taken all the efforts to arrive at proper diagnosis and treated the patient as per standard practice. The EBUS test is mainly advised to rule out tuberculosis or sarcoidosis or other pathology in the lungs. The administration of steroid in the TB patient is neither contraindicated nor had any serious adverse effect on the prognosis of disease. It was neither deviation of reasonable practice nor negligence of doctors (OP 2 and 3) at eye institute. The decision to administer intravitral injections PST and Avastin was correct in the case of disc granuloma with CRVO of right eye of the patient.

5.      Sarcoidosis and tuberculosis (TB) show epidemiological, immunological, and molecular features common to both, and often, it becomes difficult to differentiate them especially in a highly TB-endemic country like India. The case optic disc granuloma along with mediastinal TB the choice of treatment will be anti-tuberculosis therapy and oral steroids. It should be borne in mind that, ‘no cure is no negligence’. The instant complaint is misconceived and filed by the complainant with the ignorance of medical knowledge. I find here neither any deficiency in service nor any negligence caused to the patient from the treating doctors.

          The complaint is dismissed at admission stage.