Case Study

TARGETED IMAGING FOR FOETAL ANOMALIES (TIFA)

Smt. P. Shailaja v.  Dr. Y. Savitha, Revision Petition No. 163 Of 2012, decided by The Hon’ble National Consumer Disputes Redressal Commission, New Delhi on 17.09.2018.


FACTS: The complainant /petitioner consulted the respondent and was under her treatment during the course of her pregnancy, with effect from April, 2006.  On 14.8.2006, during the course of pregnancy, the complainant was advised Targeted Imaging for Foetal Anomalies (TIFA).  The aforesaid scan was done by Dr. Mahjabeen Singh, Radiologist to whom the complainant was referred to for the said imaging.  The report of TIIFA test, to the extent it is relevant reads as under:
“Echogenic Cardio focus noted in left ventricle Minor Marker for chromosomal anomalies.     Foetal mouth could not be adequately evaluated due to foetal position.  Advise review scan after two weeks.” A review scan was done on 21.9.2006 by the same radiologist and the report of the said scan to the extent it is relevant reads as under: “Placental position: Posterior upper segment lower edge well away from the internal OS grade Impress: Single live foetus. Foetal mouth appears normal.”   A child to the complainant was born on 14.1.2007 in the Nursing Home of the respondent.  The complainant also underwent Tubectomy in the same nursing home.    On 16.1.2007, it was noticed that the child was suffering from breathing problem.  The child was put on Oxygen and shifted to Care Hospital, Hyderabad for Echocardiaogram and from Care Hospital the child was shifted to Apollo hospital, for cardiac surgery.  Though the surgery was performed on 29.01.2007, the child could not be saved and died on 30.01.2007.  The allegation of the complainant is that the respondent was negligent / deficient in rendering services to her as a doctor, since neither she was informed of the infirmity found in the imaging scan on 14.8.2006 nor was she advised against tubectomy on 15.1.2007.

DEFENSE: Echogenic Cardiac Focus (ECF) noted in the TIFFA was not an indication of cardiac disease and the said finding did not warrant either further investigation or termination of pregnancy, the same being only a minor marker for chromosomal anomalies.  It was pointed out that the foetus had survived for about seven months after the said report.  As regards tubectomy it was stated in the reply filed by the respondent that the Dr. Shiva, a Pediatrician had examined the child and reported him to be normal.  It was further stated that the respondent had advised the complainant and her husband to wait for one year before going for sterilization, so as to assess the health of the newly born child in the meanwhile, but, they insisted upon immediate sterilization, which was duly performed after obtaining the requisite consent.

OBSERVATIONS: Admittedly, the petitioner / complainant had also complained to Andhra Pradesh State Medical Council against the respondent, alleging negligence on her part.  The Medical Council of Andhra Pradesh referred to the observations made by a three expert Doctors namely Dr. Sarojini Devi, Dr. P. Balamba, Gynecologists and Dr. K. Nageswara Rao, Pediatric Cardiologist, who had opined that the respondent had counseled the complainant by endorsing IEF in the pre-natal card.

Though, the above referred doctors were not examined before the District Forum, the fact remains that the observations made by them, led to Andhra Pradesh Council holding that there was no negligence on the part of the respondent.   Obviously, either the appeal was not preferred (against order of MCAP) or it was not entertained / allowed. It is evident from a bare perusal of the report dated 14.8.2006, that the Echogenic Cardio Focus (ECF) noted in the left ventricle was only a minor marker for chromosomal anomalies.  This clearly implies that the ECF was not a marker for any possible cardiac abnormality.  Therefore, it would be difficult to say that the cardiac abnormality on account of which the infant child died, could have been suspected on the basis of an echogenic focus noted in the left ventricle.  The petitioner / complainant, on receiving the above referred report dated 14.8.2006 knew that the ECF was a minor marker for chromosomal anomalies.  Nothing prevented her from consulting some other doctor for the possible chromosomal anomalies.  What is more important in this regard is that the ECF was not at all indicative of the cardiac problem which was found in the infant child and ultimately led to his death.  Therefore, even if the possible chromosomal anomalies indicated by the ECF been elaborated to her that would have of no consequence, as far as the life of the infant child was concerned.  Moreover, in the repeat scan done on 29.1.2006, by the same radiologist, no major foetus anomaly was noted.  No expert evidence or medical literature has been produced by the petitioner / complainant to satisfy this Commission, that the ECF noted in the left ventricle, which was only a minor marker for chromosomal anomalies warranted an advice to the patient for medical termination of the pregnancy on account of the said Focus alone.  Therefore, it cannot be said that the respondent should have advised the complainant to go in for the medical termination of her pregnancy on account of the ECF having been noted in her left ventricle.  The respondent therefore, cannot be said to be negligent on the aforesaid count.    As far as tubectomy of the complainant is concerned, the case sheet of the complaint would show that the during the counseling session in respect of the sterilization desired by her, she was not willing to wait for one year as had been advised.  It is therefore, evident that as far as the respondent is concerned, she had advised the complainant to wait for one year before going in for sterilization.  This obviously, was done with a view to watch the health of the newly born child in the meanwhile.  Since the complainant was not willing to wait for one year as had been advised by the respondent, it cannot be said that the respondent was negligent or deficient in rendering services to her by performing the tubectomy on her request.  The respondent therefore, cannot be said to be negligent in rendering services to the petitioner / complainant on the second count as well.

HELD: The revision petition is accordingly dismissed, with no order as to costs.

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