VIDYA BHUSHAN vs MADAN AWADHESH INSTITUTE

IN this case the complainant has alleged medical negligence by the Ophthalmologist who performed cataract operation on his left eye.

THE case of the complainant in brief is as follows: the complainant had some trouble in his left eye and on 24. 4. 1992 got himself examined by Dr. Vidya Nandan Prasad, respondent No. 2. The problem persisted and on 8. 4. 1995 he again consulted the same doctor who prescribed medicines and new glasses and directed the complainant to see him on 5. 5. 1995 on which date the complainant was asked to get some pathological tests as his eye had developed cataract and it needed surgery. On 23. 12. 1999, the doctor diagnosed that the complainant was having "presenile cataract" in his left eye and he suggested Intra Ocular Lens (I. O. L. ). Implant and he was asked to be admitted in his clinic namely "modern Eye Care". All the prescribed tests were conducted at Central Diagnostics, Shanti Apartments, Patna and fitness certificate for operation was given by Dr. S. S. Thakur. The date of operation was fixed for 3. 1. 1996 at Madan Awadhesh Institute of Modern Eye Care and Research Centre, Patna. On removal of dressings in the evening of 3. 1. 1996, the complainant found that he had absolutely no vision in the left eye on which the operation was performed. The complainant was informed by Dr. Prasad that IOL implant could not be done owing to a ''pre-existing large PC rent''. The complainant alleged gross negligence and deficiency in rendering the service by Dr. Prasad which was resulted into the irreparable damage causing complete loss of vision in the left eye. Later on the complainant consulted an Eye Specialist, Dr. Shreekant Chaudhary who after a thorough examination found that in the left eye Capsular Tag is floating pupillary area. Hence, in view of the seriousness of the matter referred the complainant to Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi or to Dr. Daljeet Singh at Amritsar.

The complainant went to Dr. Rajendra Prasad Centre which did not do anything but opined that the operation was unplanned and wrong. Therefore, the complainant submits that he had to lead a restricted life for the remaining period of his life. His movements are restricted due to permanent disability of vision which has affected his livelihood. In total he claimed Rs. 25 lakh as compensation towards expenditure incurred for operation, medicines, travelling expenses, boarding, lodging, mental agony, future treatment expenses, etc. Case of the opposite party No. 2

O. P. 2, Dr. Vidya Nandan Prasad, in his written statement has stated that the complainant had eye trouble since 1992 when he was diagnosed to have developmental cataract which means that the trouble appeared to be present in minor form since birth or early childhood. It is further stated that the cataract in the left eye of the complainant was not a senile cataract but a pre-senile cataract. Further he was rightly advised operation with I. O. L. implant. He denied that there was no vision at all in the left eye of complainant after the surgery. The patient who has cataract surgery without lens implant has vision of fingers 1 to 2 metre without glasses. Subsequently, the complainant had a corrected vision of 6/9 or (90%) vision with glasses. He submitted that pre-existing P. C. Rents are not noticeable in any of the pre-operative evaluation techniques and in the present case also, this was so because of lental opacity (cataract ). It was planned to do intra-ocular lens implant but due to P. C. Rents it was converted into "unplanned ECCE". Dr. Prasad has denied that he was arrogant and angry with the patient. If he was dissatisfied he would have gone to another doctor on the same day or next day. The complainant consulted Dr. C. M. Kohli a visiting surgeon at M. A. Institute of Modern Eye Care (respondent No. 1 ). Dr. C. M. Kohli a Vitreo-retinal surgeon, formerly a consultant in Shankar Netralay, Madras assured the patient that his eyes were all right and if the patient wants to avoid the thick glass can have a contact lens or secondary implant at a later date. With regard to the report of Dr. Shreekant Choudhary about "capsular-tags" is usuallly a normal finding after ECCE. However, this finding is not present in R. P. Centre, Delhi. Further Dr. Chaudhary has not mentioned any seriousness in the eye condition. Dr. R. P. Centre, Delhi has cecommended contact lens or secondary implant as the vision post-operative was 6/9 with + 10. 00 glasses R. P. Centre, AIIMS is a premiere eye centre of the country and the opinion given there is supportive of the earlier statment of the respondent No. 2 that the eye is not blind, it is a functioning eye and the complainant can go for secondary implant/ contact lens. Submissions: Learned Counsel for the complainant reiterated most of the points mentioned by the complainant in his complaint. He pointed out that P. C. rent means injury in the eye through which fluid comes out and this was caused during the operation. He submitted that lens implant was urgently needed as the vision of right eye was O. K. and wearing thick glasses creates double imaging. A month after the operation, the patient consulted Dr. Shreekant Choudhary who mentioned that capsular tag is floating through pupillary area and he had referred to Dr. Daljeet Singh of Amritsar or Dr. Rajender Prasad Institute, AIIMS for capsulotomy and lens implantation.

LEARNED Counsel for the O. Ps. , Submitted that it is clear from the cross-examination of the complainant that he had given consent for the operation. Further, in the cross-examination he has stated that: "i admit that my vision was deteriorated on 23. 12. 1995. On that date vision was nearly nil. I was operated for left eye on 3. 1. 1996 by OP No. 2. Before that operation the Consent Form Exhibit P. W. 1/2 was signed by me. "

The complainant has not substantiated the statement that non-implanting lens is gross negligence. Actually before the operation all the facts have been explained by Dr. Prasad. The prescription dated 23. 12. 1995 clearly indicates that the complainant had grossly impaired vision (counting fingers i. e. vision of about 6/60) in his left eye due to cataract. It further indicates that the complainant had been rapidly losing visual efficiency in his left eye. After the operation, the patient gained vision of 6/9. Perhaps patient wanted to go to Delhi or Amritsar and hence he was recommended to the hospital located there. As the complication arose during the operation, Dr. Prasad wrote unplanned ECCE-Extra Capsular Cataract Extraction since intra-ocular lens implant could not be done. He had to do ECCE. Dr. Shreekant''s observation is a normal finding after the operation. The complainant has not produced Dr. Chaudhary for cross examination. Dr. Ram Manohar Lohia Hospital to which the case was referred to for expert opinion has held that there is no negligence on the part of O. P. No. 1, Hospital or O. P. No. 2, Dr. Prasad. Findings:

(a) The comPlainant is a highly qualified, educated Person. In this case he has given consent for the oPeration. Records of the case make it clear that the comPlainant was examined meticulously and all necessary Pre-oPerative examinations were made and documented. He was made to understand all the comPlications involved in a cataract surgery. He was Provided two booklets, one containing information and guidelines about cataract surgery and the other regarding Pre-oPeration and Post-oPeration care. The comPlainant who is a lecturer having understood the things, duly signed a consent form, a coPy of which was suPPlied to him also.

(b) In his affidavit, Dr. Prasad has submitted that cataract surgery is a very delicate surgery. There are mainly 4 tyPes of cataract surgery namely, ICCE, ECCE, ECCE-IOL and Phaco. No two cataract oPerations are same and comPlications are routine. Mrs. Renuka Srinivasan, Fellow, Johans HoPkins Institute, Baltimore, U. S. A. in her book ''comPlications of Intraocular Lens ImPlantation'' has categorically stated that Posterior CaPsular RuPture or Rent (P. C. Rent) is one of the most common and also the most imPortant oPerative comPlications of ECCE. That in this Particular case a P. C. Rent was detected at the time of nucleus delivery. This Rent was covered by the DeveloPmental Cataract. However, this comPlication was managed remarkably well. In case of DeveloPmental cataract the caPsule is used to be very thin and as a Pre-existing P. C. Rent was detected, the frequency of which is used to be very high, I. O. L. was not imPlanted in the left eye of the comPlainant in the same sitting. It is submitted that if during first surgery I. O. L. could not be imPlanted wing to any comPlication it can be done at a later date when the eye becomes ''quite'' after initial surgery trauma. That in this Particular case also the comPlainant was advised by Dr. Prasad a secondary imPlant at a later date or he can use contact lens. He wrote ''unPlanned ECCE'' on the PrescriPtion dated 3. 1. 1996 because what was originally Planned was ECCE, IOL and not only ECCE and thus ''unPlanned ECCE'' was written. The comPlainant consulted Dr. C. M. Kohli, Dr. Shrikant Chaudhary and the doctors at AIIMS, New Delhi and all doctors have given advice to the comPlainant similar to the advice given by him on 3. 1. 1996, that is, for the secondary imPlant or to use contact lens.

(c) It is also clear from the records that Dr. Prasad is a highly qualified OPhthalmologist with several years of exPerience. The Patient was loosing eyesight Progressively in his left eye which resulted in Pre-senile cataract for which Dr. Prasad had conducted the Prescribed oPeration. The Patient had consulted several Doctors, Dr. C. M. Kohli, Dr. Shrikant Chaduhary and also the doctors at AIIMS, New Delhi. None of them have oPined that there was negligence on the Part of the oPerating surgeon. It is clear from the cross-examination of the comPlainant that his vision in the left eye Prior to the surgery was nil and after the surgery he could gain vision of 6/9 with the helP of glasses. He has not Produced any authoritative medical oPinion of any exPert doctor to Prove his contention that the oPerating surgeon was negligent on any count.

(d) On 12th January, 2005 when the learned Counsel for both the Parties were Present while hearing arguments it aPPeared that for a just decision in the matter, exPert oPinion should be obtained. Accordingly, Medical SuPerintendent, R. M. L. HosPital was requested to obtain an exPert oPinion from either the Head of the DePartment of OPhthalmology or any other senior doctor in that dePartment on the Point of medical negligence in Performing the oPeration on 3. 1. 1996 by Dr. Vidyanandan Prasad. A comPlete set of PaPer-book including medical record available was sent to the Medical SuPerintendent, RML HosPital by the Registry. Dr. Shashi Vashisht, Head of the DePartment, OPhthalmology, Dr. R. M. L. HosPital has given the following oPinion: "the diagnosis of develoPment oPacity lens (cataract) was made PreoPeratively (PrescriPtion dated 8. 4. 1995 ). The rePorted incidence of Pre-existing Posterior caPsular defect is about 7% in such cataracts. ProPer treatment was instituted as for a case of Posterior caPsular tear/defect. Patient has 6/9 vision with glasses Post oPeratively. This, therefore, does not tantamount to negligence". (e) What is exPected from a doctor in a case like this? SuPreme Court of India in Dr. Laxman Balkrishna Joshi v. Dr. Trimbak BaPu Godbole and Anr. , AIR 1969 SC 128, lays down the criteria for determination of the Professional duty of a medical man in the following way: "a Person who holds himself out ready to give medical advice and treatment imPliedly undertaken that he is Possessed of skill and knowledge for the PurPose. Such a Person when consulted by a Patient owes him certain duties, viz. , a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to give, or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the Patient. The Practitioner must bring to his task a reasonale degree of skill and knowledge and must exercise a reasonable degree of care. "

(f) In this case we find that that Dr. Prasad Possessed adequate skill and knowledge to handle this case and he has exercised the duty of care in undertaking the case, duty of care in deciding what treatment to give and duty of care in the administration of that treatment. He has brought to his task a reasonable degree of skill and knowledge and has exercised a reasonable degree of care.

THE complainant has not attributed any negligence on the part of opposite party No. 1. Accordingly we hold that there is no negligence on the part of the opposite party Nos. 1 and 2. The complaint is accordingly dismissed. Complaint dismissed.