New Delhi: The Delhi High Court bench of Justice Subramonium Prasad stated that the award of punishment by the National Medical Commission (NMC) or State Medical Councils should not be considered a decisive factor in determining the fault or inadequacy of a medical professional under various laws. The court effectively stated that cases filed by the patient that sought compensation under consumer protection act or criminal complaint in a competent court filed by the patient will be adjudicated by the merit of the case and will not be influenced by the outcome of the award of punishment by the NMC.
The facts of the case are that the patient Ravi Rai was admitted to Fortis Hospital due to injuries and was attended by a casualty medical officer and a senior resident from the Department of Orthopaedics. Mr Rai alleged that despite having a fracture on his left foot and spine, the orthopaedic doctors did not informed the physiotherapist about these injuries and instead the physiotherapist was instructed to help Mr. Rai stand up with the help of a walker. Mr Rai further alleged that instead of operating on the right foot, which had a comminuted fracture, the petitioner’s left foot was operated on. Surprisingly the orthopaedic doctors stated in his defence that the change in plan to operate the left foot instead of the right foot was made in the Operation Theatre (OT) when excessive swelling was found on the right lower limb after removing the plaster. However, this change was not conveyed to the patient or to Dr. Sharma, the Anaesthetist. Mr Rai also said that no written consent was taken regarding the change of plan or surgery being carried out on the left side. Also it was alleged that there was tampering of the record as while there was no pre-operative mark on the patient’s left limb, the WHO Check-list showed the mark on the left side.
The Delhi Medical Council accepted the findings of the Disciplinary Committee and recommended that the names of the orthopaedic doctors to be removed from the State Medical Register of the DMC for a period of 180 days. Two separate appeals were preferred by both the orthopaedic doctors before the erstwhile Medical Council of India. The MCI exonerated one of the orthopaedic doctor on the ground that he was absent on the day of the surgery due to personal reasons and was not present in the operation theatre when the surgery was performed on the Petitioner. The MCI sustained the punishment awarded to the other orthopaedic doctor. As one of the orthopaedic doctors was exonerated Mr.Rai approached the High Court stating that the exoneration of one of the orthopaedic doctor will affect the FIR filed by him against the orthopaedic doctors.
The High Court, in its judgment, stated that the award of punishment by the MCI cannot be an indicator to decide on any fault, imperfection, shortcoming or inadequacy in the quality, nature and manner of performance which is required to be maintained by or under any law for the time being in force or has been undertaken to be performed by a person in pursuance of a contract or otherwise in relation to any service which is required to be maintained under law. The competent Courts are directed to proceed ahead with the case on facts without being influenced by the quantum of punishment awarded to the Doctors herein by the MCI.
Legal Prescription
- In elective surgery the doctor must ensure that they take written informed consent from the patient if there is a change in the treatment plan
- If a medical procedure involves a team of healthcare professionals, there should be clear communication and coordination among all team members.
- The team of healthcare professionals involved in the treatment should be aware of the patient’s condition at all time and should co-ordinate with each other during the course of the treatment
- Doctors should conduct a thorough examination of the patient’s condition, including reviewing all diagnostic tests and scans, before deciding on a treatment plan
- Doctors should do proper documentation and should avoid over-writing patient’s medical records as it brings suspicion of wrong-doing before the court