Case Study

WRONG DIAGNOSIS IS NOT MEDICAL NEGLIGENCE

Sh. Vinod Jain v. Santokba Durlabhji Memorial Hospital, CIVIL APPEAL NO.2024 of 2019 decided by the Hon’ble Supreme Court of India on 25.02.2019.


Facts: Late Mrs. Sudha Jain was the wife of the appellant, who was suffering from various diseases – oesophageal cancer (past history of colon and breast cancer), hypertension and type 2 diabetes. The occasion to be admitted to respondent No.1-Hospital and being treated by respondent No.2-Doctor on 15.10.2011 was chills and fever as also for re-insertion of nasal feed tube, stated to be dislodged due to severe dysphagia. She was attended to by respondent No.2-Doctor for the chill and fever, and nasal feed tube was inserted on the same day by Dr. Anurag Govil, with some allied tests prescribed to be carried out. One of the tests was a Complete Blood Count Report, which found that the WBC count was high, indicative of infection. She had also running temperature of 104 degrees Fahrenheit, and her medical treatment commenced with intravenous administration of injection Magnex of 1.5 mg. As per the medical reports, the cannula used for intravenous treatment stopped functioning and respondent No.2-Doctor prescribed a further antibiotic tablet, Polypod (Cefpodoxime) to be orally administered through the nasal tube. The patient was discharged from respondent No.1-Hospital on 18.10.2011, at which stage also her WBC count was high and she was prescribed to continue taking her medicines for a period of 5 days post discharge, which apparently was administered to her, as per the appellant. The appellant claimed that on 23.10.2011, his wife went into coma and had to be admitted to a nearby Heart and General Hospital, where she was put on life-support ventilation system. The WBC count of the wife of the appellant had risen even further. Her health continued to deteriorate and she was required to be shifted to the Fortis Escorts Hospital, where she finally succumbed to her illness on 31.10.2011. The appellant sought to make out a case of: (a) inappropriate and ineffective medication; (b) failure to restart the cannula for IV medication; (c) premature discharge of the deceased despite her condition warranting treatment in the ICU; (d) oral administration of Polypod antibiotic, despite her critical condition, which actually required intravenous administration of the medicine.

Defense: When the patient was discharged, she was afebrile, her vitals were normal and she was well-hydrated, with no infection in her chest or urinary tract. She was stated to be clinically stable from 15.10.2011 to 17.10.2011 and that is why she was so discharged on 18.10.2011, with proper medical prescriptions for the next 5 days. However, the State Commission found in favour of the appellant and directed a compensation of Rs.15 lakh and costs of Rs.51,000/- to be paid to the appellant. Aggrieved by the said order of the State Commission, the respondents preferred an appeal before the NCDRC, which exonerated the respondents of any medical negligence vide impugned order dated 1.8.2017. It was opined that at the highest, it could be termed as a case of wrong diagnosis and certainly not one of medical negligence.

Observations: It is material to note that the respondent No.1-Hospital promptly attended to the wife of the appellant. Respondent No.2, physician, once again, attended to her promptly, and started her on antibiotic treatment. The nasal feed tube was re-inserted promptly. However, in the early hours on the next day, on 16.10.2011, the cannula stopped functioning and instead of re-cannulating the patient, oral administration of the antibiotic Polypod was found justified. It is this aspect, which according to the appellant, amounts to medical negligence. The explanation offered by respondent No.2-Doctor was that when he attended the patient at 11:00 a.m. on 16.10.2011, he found that the drip had been disconnected, on account of all peripheral veins being blocked due to past chemotherapies, and that the drip had been stopped, the night before itself, at the instance of the appellant. Taking into consideration the fact that the patient was normal, afebrile, well-hydrated and displayed normal vitals, the oral administration of the tablet was prescribed. This, according to the NCDRC was the professional and medical assessment by respondent No.2-Doctor, arrived at on the basis of a medical condition of the patient, and could not constitute medical negligence. We see no reason to differ from the view expressed by the NCDRC, keeping in mind the test enunciated aforesaid. Respondent No.2 – Doctor, who was expected to bring a reasonable degree of skill, knowledge and care, based on his assessment of the patient, prescribed oral administration of the antibiotic in that scenario, especially on account of the past medical treatments of the wife of the appellant, because of which the veins for administration of IV could not be located. Her physical condition was found to be one where the oral administration of the drug was possible. The appellant has also sought to make out a case that the blood culture report required his wife to be kept in the hospital. This was again a judgment best arrived at by respondent No.2-Doctor, based on her other stable conditions, with only the WBC count being higher, which, as per the views of the respondent No.2-Doctor, could be treated by administration of the antibiotic drug orally, which was prescribed for 5 days, and as per the appellant, was so administered. In the perception of the doctor, the increase in lymphocytes in the blood count was the result of the patient displaying an improved immune response to the infection. It is in this context that the NCDRC opined that at best, it could be categorised as a possible case of wrong diagnosis. In our opinion the approach adopted by the NCDRC cannot be said to be faulty, while dealing with the role of the State Commission, which granted damages on a premise that respondent No.2-Doctor could have pursued an alternative mode of treatment. Such a course of action, as a super-appellate medical authority, could not have been performed by the State Commission. There was no evidence to show any unexplained deviation from standard protocol. It is also relevant to note that the deceased was medically compromised by the reason of her past illnesses. The deceased was admitted to two other hospitals, post her discharge from respondent No.1-Hospital.

Held: The moot point was whether her admittance and discharge from respondent No.1-Hospital was the sole, or even the most likely cause of her death. The death had been caused by a multiplicity of factors. In the end, we may also note that the medical certificate issued for the cause of death by Fortis Escorts Hospital cited septic shock due to multiple organ failure as the immediate cause of death, with her diabetic condition being an antecedent cause, as also the multiple malignancies, post chemotherapy and radiotherapy all contributing to her passing away. We cannot fault the reasoning of the NCDRC. Thus, the result is that the appeal is dismissed, leaving the parties to bear their own costs.

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