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--------------- Print Magazine --------------
  May 2016
  April 2016
CASE STUDY - by Anoop K. Kaushal

Medical Malpractice and Regulatory Control

Goyal Hospital & Research Centre Pvt. Ltd. v. Kishan Gopal Shukla

Revision Petition No. 4023 of 2011 pronounced on 7 th May, 2013 by the Hon'ble National Consumer Disputes Redressal Commission, New Delhi.

Facts: Smt. Vibha Sharma wife of Complainant No. 2 Mr Raju Sharma, consulted Dr. Kailash Dubey on 11-2-1999 for her health problems who diagnosed volvular disease of the heart and advised her for further checkup from some Cardiologist. On 12-2-1999 complainant took his wife to Dr. Anand Goyal (OP-2), who claimed himself a Cardiologist, conducted tests pertaining to heart problems on Vibha Sharma and diagnosed as Mitral Stenosis with Mitral Regurgitation (MS with MR) and started treatment. Meanwhile, Vibha became pregnant, kept visiting regularly Goyal Hospital for her pregnancy checkup with Dr. Sharada Mathur (OP-3) and for heart problems check up with Dr. Goyal (OP-2) till her eight months of pregnancy i.e. till October 1999. During this period there was no improvement in the health of Vibha and she was admitted twice to Goyal Hospital from 25 - 27-8-1999 and 21-23-10-1999 for minor complaints. During the eighth month of pregnancy on 27-10-1999 Vibha visited the Goyal Hospital and the OP-3 -referred her to Dr. R.K. Vyas, a Cardiologist for opinion. Dr. R.K. Vyas on examination advised urgent hospitalization and further to undergo delivery operation at the earliest. On the same day by evening at about 5 pm. OP-3 performed caesarian operation of Vibha and delivered a male baby. Post delivery, Vibha's condition deteriorated, landed into coma and was shifted to ICCU after four hours and on the next morning, she was declared dead on 28-10-1999.

Observations: The OP-2 Dr. Anand Goyal who is post- graduate-Doctor of Medicine (MD Gen Med) was not a Cardiologist who examined Vibha Sharma on 12-2-1999. After clinical assessment and proper investigations and by 2D Echo study diagnosis in this case mentioned as "Early Pregnancy and MS with MR, Enlarged LA, Moderate Non Calcific Mitral Stenosis" and advised Doppler study. Vibha was in early pregnancy and was suffering from the Heart Valve Disease and was advised complete rest and avoid use of salt (Sodium). The OP-3 Dr. Sharada Mathur, a Gynaecologist of the same hospital (OP-1) diagnosed her pregnancy of two months. During follow-up treatment for her pregnancy, she visited
Dr. Sharada Mathur (OP-3) on
8-5-1999, 14-6-1999, 15-7-1999 and 19-8-1999. During the follow up period on account of uneasiness Vibha was admitted for two days each from 25-8-1999 to 27-8-1999 and from 21-10-1999 to 23-10-1999. The condition of patient Vibha did not improve but deteriorated inspite of treatment of respondents. On 27-10-1999 when the breathlessness and uneasiness increased she was taken to respondent's hospital. She was examined by Dr. Sharada Mathur who referred her to Dr. R. K. Vyas, a Cardiologist who diagnosed Vibha as "RHD, Mod.Mitral Stenosis, Mitral Insufficiency with Atrial fibrillation, CCF" and mentioned the advise for "Hospitalization and plan for delivery by Caesarean as early as possible with explained risk during surgery". OP-3 conducted Caesarean section operation and delivered male baby. After delivery patient went into coma, was shifted to ICCU, but unfortunately died on next day morning of 28-10-1999. OP-2 himself stated that he being holder of degree MD was competent to treat heart ailment and he has not denied the fact "Consultant Physician and Cardiologist" is printed on prescription slip, specifically admitted that he did not consider any need for terminating the early pregnancy of Vibha seeing good condition of her health. Accordingly it becomes an admitted position that without having any such degree of specialization in heart disease he started treatment for heart disease (MS with MR) of Vibha from 12-2-1999 and continued treating till her last breath on 28-10-1999. Dr. R.K. Vyas, a Cardiologist qualified as having diploma in cardiology from Vienna City, Austria, clearly stated that Dr. Anand Goyal was not a cardiologist. He in this context stated that "it is correct that any doctor even if he is simple M.D., cannot claim of being cardiologist i.e. Specialist in Heart Disease." Dr. Anand Goyal properly got printed consultant physician as also cardiologist on his letter pad which he certainly was not competent and qualified to write this and he in this regard misled and created wrong impression. As per Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002 dated 11 th March, 2001, the duties and responsibilities of the physician have been notified.

Clause-B Sub-clause 1.1.3 states as under:

" No person other than a doctor having qualification recognized by Medical Council of India and registered with Medical Council of India/State Medical Council(s) is allowed to practice Modern System of Medicine or Surgery."

Similarly, Clause B-1.2.1 states as under: "The physician should practice methods of healing founded on scientific basis and should not associate professionally with anyone who violates this principle."

Even otherwise, undergoing several trainings, attending workshops in Cardiology did not confer qualification of Cardiologist. Hence, it is not recognized by MCI or Rajasthan State Medical Council.

OP-2 submitted that on 25-3-1999 Vibha was patient of Mitral Stenosis with Mitral Regurgitation Grade I disease which is not safe to do Medical Termination of Pregnancy (MTP). But Dr. R. K. Vyas in his statement on oath stated that " keeping in view the disease of Vibha and treatment in this regard and entire condition, it was the safest course for her to get her M.T.P. performed on 25-3-1999 itself i.e. at her early pregnancy stage itself. It would have been the safest course to get her M.T.P. done because the risk to the life of patient increases with the duration of pregnancy stage increasing." Therefore, it is crystal clear that the OP-2 was well aware and he anticipated the complications of MS/MI during pregnancy who ought to have advised MTP in early pregnancy or would have referred to Cardiologist for proper management. By not doing so, it can be said that there is a Medical Negligence on the part of the OP-2. OP-3 a Gynaecologist did not prudently think of taking opinion of Cardiologist in the early pregnancy of Vibha or she would have been prudent enough to advise for termination of pregnancy (MTP). Dr. Anand Goyal in his reply and affidavit has not stated anywhere that he himself was present at that time in the operation theatre.

Held: As per MCI norms OP-2 is not qualified to treat Smt. Vibha who was the patient suffering from volvular disease. A doctor who is not qualified and competent to do so amounts to therapeutic misadventure. There is no evidence which may show that the OPs have given proper treatment during course of pregnancy. The OP-2 if he is a Cardiologist should have performed intervention like Percutaneus Mitral Valvutomy (PMV) or Commisurotomy. But, on 27-10-1999 at the eleventh hour i.e. after the lapse of 8 months of pregnancy the OP 2 and 3 referred such critical patient Vibha to Dr. R.K. Vyas, a Cardiologist; this is not acceptable and not a standard of medical practice at all. OP 2 and 3 committed deficiency in service by not proper referral and treated as a Cardiologist right from the beginning till prior to 27-10-1999. (There is ) some element of negligence by an anaesthetist Dr. Shobha Pareek (OP-4). The patient Vibha was in CCF (Congestive Cardiac Failure); the standard and preferred practice to anaesthesia is spinal anaesthesia. But, OP-4 administered General Anaesthesia for Caesarian Section instead of better option of trying vaginal delivery with Combined spinal-epidural analgesia which would produce good analgesia without major haemodynamic changes. There is medical negligence by all the opposite parties mainly OP No.2. This case on hand throws ample light upon rampant unethical medical practices in India. Nursing homes, hospitals provide facilities like diagnostic Laboratory, Radiology or Sonology units without specialists like Radiologist, Pathologists. Such units are managed by unqualified or untrained staff. It appears that such doctors have erased the Hippocratic Oath from their mindset and are more active in a business of profiteering by coercive methods and by creating false impression in the minds of patients at large. The Apex Court in various judgments has clearly observed that; unless the person holds a necessary qualification, should not perform job of the Specialist. I would like to set this as an advisory /direction to the statutory bodies like Medical Council of India (MCI) and Health Ministry to initiate steps to strike down such practices of medical professionals who are posing as a specialist or mis- representing as a super specialist without any approved qualification by statute or controlling authority. In other words it is a "QUACKRY" - treating the patients in absence of valid degree. Such misleading display of qualifications or misrepresentation will harm the quality of health system in India. Subsequently the innocent patients are victimized financially and also lose their precious life. For such instances the entire medical fraternity cannot be branded as lacking in integrity or competence "because of some bad apples". Copies of this order be sent to Medical Council of India (MCI) and Health Ministry for information.

The petitioners are directed to pay ` 6,82,000 along with additional punitive cost of ` 1,00,000 out of which ` 50,000 will go to the complainants/respondents and ` 50,000 be deposited with Consumer Welfare Fund.

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