Following questions come for consideration: Whether the Scanning Centre was negligent in not giving a detailed report regarding the deformities of the feotus in the first scan conducted on 11.2.2011? and If the treating doctor was negligent in not advising an earlier scan and more importantly in not specifying the time frame within which it ought to be conducted, considering the age of the patient as most abnormalities are detected between 18 to 20 weeks the age of the feotus? What can be gathered from the medical literature and the material on record is that it is the duty of every prudent sonologist to study the USG in detail? Whether the Complainants could have gone for MTP or not is an option which the Complainants could exercise legally or not and that is not the issue of medical negligence which needs to be given a finding to? Why the treating doctor (Obst. & Gynecologist) did not suggest such a scan to be done as a precautionary measure in a timely manner for a patient who was 33 years old and is at comparatively higher risk, specially keeping in view the light of the fact that MTP Act does not permit termination after 20 weeks? Whether the termination could be done after the 20th week or not and given a finding on the wrong premise that MTP Act does not permit termination after 20th week, while the case was with respect to negligence on behalf of the Scanning Centre in not detecting anomalies in the first ultrasound report dated 11.2.2011 and also a negligence on behalf of the treating doctor in not advising an earlier scan? What should be a correct diagnostic approach? What do you mean by a ‘standard obstetric ultrasound examination’? What is the Duty of Radiologist/Obstetrician and Gynecologist? What is proportion of Compensation to be paid by Radiologist/ Obstetrics & Gynecologist? Who will pay the amount of compensation awarded? What is the time for payment? What if compliance not done? What are the Indications for LSCS?

Overview • Article 19, 21 of the Indian Constitution • Right to Information Act, 2005 • Right to Privacy /Confidentiality • Exceptions to rule • Procedure of Getting Information • Medical Record • Medicolegal Documents • Ethical Regulations, 2002 • Case Law (Fortis Case) • Who is asking for Information (MR)? • Who is Third Party? Information under Statutory Provisions? • Why Information (MR) needed by Patient? • Who can get Information (MR)? • Right to Information Act, 2005 • Consumer Protection Act, 1986 • The Medical Council Act, 1956 (The Indian Medical Council (Professional Conduct, Etiquettes and Ethics) Regulations, 2002

A case of misleading advertisement and unfair trade practices adopted by a hospital in HARYANA.

Doctor may be deprived right to practice for improper misconduct with his patient in India? Professional death sentence is a highest punishment awarded to a physician by the State Medical Council/ Medical Council of India to a Registered Medical Practitioner in India for offences involving moral turpitude, conviction by the court and Adultery or improper conduct with a patient. It is probably the first case in India after the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 come into force. Professional Death Sentence (PDS) means erasure of name of physician (Registered Medical Practitioner) from the Indian Medical Register (IMR) /State Medical Register (SMR). Thus, delinquent physician loses right to practice modern medicine for whole life.

Questions for Consideration before NCDRC: 1. Whether adequate Cardiac Monitoring of the Patient was done before subjecting her to Chemo? 2. Whether there was any deficiency in treatment of the Patient? 3. What ought to have been done by the Doctors in charge of Chemo that had not been done? 4. Whether the dosage was excessive? 5. Whether at the 6th cycle of Chemo Opposite Parties had failed to determine proper dose of Adriamycin? 6. Whether a proper valid consent was taken from the Complainant? Accordingly, NCDRC directed that, out of the total compensation of ₹2000000/-, the Hospital shall

Ld. District Forum came to the conclusion that it was because of the wrong method of administration of the gluteal injection; there was damage of the sciatic nerve on right side. The district forum awarded compensation to the patient to the tune of Rs. 3 lakh with the interest rate of 10% per annum. Being aggrieved by the order of the district forum, doctor has filed appeal before SCDRC. Considering the submissions made before SCDRC, considering record and scope of the appeal, following points arise for determination and accordingly findings thereon are noted against them for the reasons given below: 1. Whether there was deficiency in service given by the doctor to complainant? No 2. Whether complainant is entitled for compensation? No 3. What Order? As per the final order. In the view of the above findings, SCDRC passed the following order. “ORDER 1. The Appeal is partly allowed with no order to costs. 2. The impugned order dated 01/04/2014, passed by the Ld. Additional District Consumer Disputes Redressal Forum, Suburban Mumbai, at Bandra in complaint no.279 of 2011 is hereby set aside. 3. It is hereby declared that, there is no deficiency in service and medical negligence while giving treatment to the opponent, the original complainant. Case deals with issue of medical negligence in giving injection and consequential damage suffered by the patient. Various case laws relied on the issue of medical negligence and Bolam Test applied in this case and SCDRC exonerated doctor from the charges of medical negligence.

Following Issues discussed: Punitive damages, administrative deficiency, Importance of medical records, communication, attitude, unsympathetic behavior of the hospital administration, Normal standard medical practice, ATECOM Module of MCI, Expert Evidence, Difference of Opinion Abbreviations: • NICU: Neonatal Intensive Care Unit • ANC: Ante Natal Care • IPPR: Intermittent Positive Pressure Respiration • RDS: Respiratory Distress Syndrome • PPHN: Persistent Pulmonary Hypertension of the Newborn

The role of the preliminary scan for structural assessment has been recently recognized and shows that doctor’s commendable effort to check the fetal structure and reported everything accurately. When the OP-3 to OP-6 stated “both hands visible”, it was described having seen two hands at the time of the scan. In this condition, the hands are mobile in almost all planes and directions, it is not impossible to mistake the same hand at two different positions as two different hands. Antenatal scans of living and moving fetuses have limitations to accuracy. It is due to these limitations most scan centers attach long disclaimers at the end of the scans such as “all fetal abnormalities cannot be picked up by ultrasound scans. Detection of fetal anomalies depends on fetal position, penetration of ultrasound waves through maternal abdomen, gestational age of the fetus etc. Some abnormalities develop as the fetus grows and some congenital problems present only postnatal”. Technical limitation of the scan cannot be equated to negligence by the doctors/opposite parties. [Para 5] Important issues discussed: • Liability of Hospital /Surgeon/Radiologist/Gynecologist • Cross Examination • Res Ipsa Loquitur • Vicarious Liability • Duty of Care • Degree of Care • Medical Literature • Case Law • Wrong Diagnosis/ Error in Diagnosis Questions for consideration: • Whether the opposite parties committed any deficiency in service in not diagnosing the deformity of the right hand of the complainant no.3? • Whether the complainants are entitled to any compensation? • To what relief?

Medical Negligence due to lack of proper care and resulting damage result in deficiency in service and consumer court can award damages for loss suffered by the patient. Role of second opinion and informed consent after providing adequate information is very important in appropriate case. A case of ‘Sinonasal Polyposis’ with ‘intra orbital extension’ came for treatment before an ENT Specialist in Apollo Hospital who without second opinion of ophthalmologist performed ‘Functional-Endoscopic-Sinus-Surgery (FESS)’. A rare complication occurred and patient suffered loss of vision. ENT Specialist failed in its duty to ask for second opinion of ophthalmologist and failed to take informed consent regarding rare complication. Although SCDRC awarded compensation of Rs.3/- Lacs, which was confirmed by NCDRC in appeal, but label it as therapeutic misadventure. This case reminds the importance of opinion of specialist in appropriate case. Main question for consideration before the NCDRC was: Whether the Ophthalmologist’s opinion was necessary before performing FESS?

Terminology of pathology report and interpretation of opinion should be left to the attending doctor not to the patient or their relatives. In this case it is pertinent to mention that one of the members of NCDRC Bench itself was a pathologist doctor i.e. why case was understood and decided in favour of doctor/Hospital as he was able to explain the complexity of problem. Issue of Diagnosis, Pathology report, Terminology and Interpretation of report, reputation of Surgeon, Pathologist were at stake. Following questions need answers: • Whether the patient had malignancy or not? • Why there is need for other test before operation? • Is those test amounts to unnecessary investigations? • Is there no need for trust/faith between doctor and patient? • Who is responsible for such scenario? • What is defensive medicine? One of the Member of Bench of NCDRC was itself a pathologist