Vision Loss Due to Undiagnosed Malignancy in Optic Nerve, NCDRC slaps Rs 20 lakh compensation for negligence
New Delhi: Holding that due to an incorrect MRI scan, there was a delay in treatment which ultimately resulted in loss of vision in the patient’s left eye, the National Consumer Disputes Redressal Commission (NCDRC) recently upheld the order passed by Chandigarh State Commission directing a diagnostic and scanning centre to pay Rs 20 lakh compensation to the patient.
It was alleged that the vision loss was on account of the optical nerve being infected with a malignant growth which was not depicted in the report.
The complainant/patient (minor) filed a consumer complaint through his father against the scanning centre for alleged negligence by the doctor running the scanning centre contending that the report of imaging dated 13.01.2007 was a wrong report, contrary to the images that existed and which were necessary to be mentioned for a proper diagnosis.
The complainant alleged that because of the incorrect and wrong report, the treatment of the patient could not be undertaken timely and was delayed. This ultimately resulted in the loss of vision in the patient’s left-eye. The loss was on account of the optical nerve being infected with a malignant growth which was not depicted in the report dated 13.01.2007.
It was claimed by the complainants that had the correct radiological symptoms been recorded, the patient would have immediately undertaken the follow-up treatment which could not be accomplished due to this incorrect reporting by the diagnostic centre.
After considering the complaint and examining the evidence, facts and sequence of events, the State Commission, Chandigarh concluded that there was deficiency and a lapse amounting to negligence on the part of the scanning centre by giving a wrong MRI report. Holding the scanning centre liable to compensate the complainant on account of loss of vision of the left eye of the complainant, the State Commission ordered the scanning centre to pay Rs 20 lakh compensation and Rs 10,000 litigation costs to the complainant.
Challenging the order of the State Commission, the Scanning Centre appealed to the National Consumer Disputes Redressal Commission (NCDRC). It was argued by the counsel for the Scanning Centre that the Complainant along with his guardian came to the appellant Clinic/Scanning Centre on their own without any prescription or medical advice from any medical practitioner and requested for an ordinary MRI Scan.
The Scanning Centre argued that the complainant’s father was advised to seek a specialist’s opinion for specifying the area and type of scan required to be done but the he did not adhere to this and insisted on the doctor of the scanning centre conduct a routine MRI of the brain without any injection of any medicine. The MRI Scan was done and the father was advised to consult a specialist doctor for proper medical treatment.
Referring to the MRI report dated 13.01.2007, the scanning centre argued that the report did not indicate any abnormality in the ‘Sella’ region, orbits and retroorbital spaces. Apart from this, the scanning centre further argued that the delay in the treatment initiation could not be attributed to the initial MRI report.
The counsel for the scanning centre referred to the eye examination at Grewal Eye Institute on the same day where the vision of the right and the left eye was reported to be 6/5 and 6/6. Referring to this, the counsel argued that there was no abnormality of vision as of the date when the eyes were examined at Grewal Eye Institute and therefore, the imaging report did not suffer from any infirmity nor could it be suspected to be wrong.
Further, the counsel referred to the eye examination at Prakriti Brain & Nerve Research Centre on 19.01.2007 where a provisional diagnosis at that stage indicated a suspicion about a sharp decline in the vision but the same was suspected on diagnosis due to Mild Refractory Errors and therefore, advice was given for other clinical and medical examination. Referring to these, it was argued that even these doctors could not locate any indication of a suspected malignant abnormal growth. Reliance was also placed on the report of an eminent neurologist Dr. Chopra who provisionally diagnosed that there were no neuro defects and it was a possible headache or migrane and went to the extent of saying that the behaviour of the patient could be functional.
Referring to these reports, the counsel for the scanning centre argued that there were no symptoms to possibly detect or suspect any other possibility at that moment.
Later, the patient was taken to the Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh and was examined as an out-patient on 31.01.2007 with advice to be checked for Relative Afferent Pupillary Defect (RAPD). The follow-up review was undertaken and on 05.02.2007, he was examined in the neurology department of PGIMER, where Dr. Lal suspected a possible growth on the left side and advised an MRI.
As per the counsel for the scanning centre, this was the first clinical diagnosis by an expert in that field suspecting a growth. Following this, the complainant and his father came to the appellant Scanning Centre and on 05.02.2007 a Contrast MRI was conducted on the said prescription. On this, the contrast MRI according to the appellant, disclosed a growth enclosing and superimposing the optic nerve of the left eye of the complainant measuring 5.28 x 3.8 x 3.87 cms. The report also categorically stated that the said growth was causing bilateral optic nerve compression in the regions concerned. While reciting the impression it was also recorded that the growth was most likely an aggressive fungal infection (invasive aspergillosis).
The complainant alleged that the doctor took the earlier reported dated 13.01.2007 and applied a whitener over the word “Sella” in that report. The complainant alleged that this was done intentionally, possibly to reflect as if no imaging was done with regard to the Sella region. However, the counsel for the scanning centre argued that this allegation was incorrect as the said report was in the custody of the guardian of the complainant.
Meanwhile, the counsel for the patient argued that the initial MRI report was incorrect and the doctor failed to identify the malignant growth compressing the optic nerve. Later examinations and reviews of the same MRI scan confirmed the presence of the growth, indicating negligence in reporting the initial MRI.
It was further contended that the disease aggravated between 13.01.2007 to the second contrast MRI conducted on 05.02.2007 and this ultimately badly affected and compressed the optic nerve of the left eye. The severity of this aggressive development was such that the patient virtually lost his left eye-sight due to this negligence.
While considering the matter, the top consumer court noted that the initial MRI was done voluntarily by the patient’s father as a precautionary measure, without any prescription or provisional symptoms. There was no indication of any growth in the ocular region and even subsequent examinations did not initially detect any suspected growth.
However, a growth was suspected after the child underwent a more detailed examination at PGIMER, Chandigarh where the doctor advised for a contrast MRI. This second MRI confirmed that there was a growth compressing the optical nerves.
The top consumer court referred to subsequent reports from medical institutes confirming the existence of a growth even in the initial MRI scan dated 13.01.2007.
“…the 13.01.2007 report was not correct and this error was not an error of judgment on the part of the Appellant but was sheer negligence. Had the report been correctly recorded or any doubt expressed about any growth, the same would have been a different story. But on a perusal of the report dated 13.01.2007, it is clear that the Appellant had clearly opined that there was no abnormality seen in the ‘SELLA’ region. This is contrary to what was confirmed later on 09.12.2009 by the Rajiv Gandhi Cancer Institute, even though the other doctors who had examined the Complainant between 13.01.2007 and 05.02.2007 had not been able to suspect the same,” opined NCDRC.
Upholding the opinion expressed by the State Commission, the NCDRC bench noted,
“The report on imaging is exclusively a responsibility of the Appellant and therefore, in view of what has been said in the Reports dated 09.12.2009 of Rajiv Gandhi Cancer Institute and Research Centre and 28.12.2010 of the Grewal Eye Institute confirms that the report about the imaging as transcribed and recorded on 13.01.2007 was misleading. There is no evidence or plausible explanation contradicting the said reports by the appellant. This negligence, therefore, cannot be ruled out and the preponderance of probabilities given the circumstances aforesaid lead to the conclusion that the Appellant was negligent in discharging the professional duties that is expected of a medical practitioner of the field possessed of ordinary skills. Consequently, the conduct and omission of the Appellant Dr. ***, clearly qualifies as a negligence on her part. Therefore, the State Commission has rightly proceeded to hold her liable.”
Although NCDRC acknowledged the difficulty in determining the quantum of compensation, it upheld the Rs 20 lakh compensation awarded by the State Commission.
“In my considered opinion, keeping in view the life-span of the child who may now have joined the legal profession as orally urged by the learned Counsel for the Appellant, has suffered a loss including physical harassment and of course will continue to be agonized throughout his life. It is, thus, not only the actual loss suffered by him but also the expected disadvantages which he is likely to suffer in future. With a vision of only one eye, he is bound to face disadvantages in his legal profession as well as his personal life. The prospects of a marriage and future employment would be marred by this handicap. Considering the age-span and the overall circumstances of the case and also the fact that no Appeal for enhancement has been filed by the Complainant, I see no reason to interfere with the amount of Rs.20 lacs awarded as compensation to the Complainant which appears to be just and reasonable,” it observed.
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/ncdrc-scan-centre-234895.pdf
