DMC/DC/F.14/Comp.520/2009/ 30th June, 2009

ORDER

The Delhi Medical Council examined a complaint of Smt. Shefali Biswas, forwarded by Medical Council of India, alleging medical negligence on the part of Dr. Lopamundra Sarkar, in the treatment administered to the complainant at Safdarjung Hospital, New Delhi.

The Delhi Medical Council perused the complaint, joint written statement of Dr. Lopamundra Sarkar and Dr. Anuj Mehta, Senior Eye Specialist for Medical Superintendent, Safdarjung Hospital and written statement of Medical Superintendent, Centre for Sight, B-5/24, Safdarjung Enclave, New Delhi, rejoinder of complainant, copy of medical records of Safdarjung Hospital & Centre for Sight, AIIMS and other documents on record.
The following were heard in person :-
1) Shri D. Biswas Son of the complainant
2) Dr. Lopamundra Sarkar Ophthalmologist, Safdarjung Hospital
3) Dr. Anuj Mehta Senior Eye Specialist, Safdarjung Hospital
4) Dr. K.T. Bhowmik Additional Medical Superintendent, Safdarjung Hospital
5) Dr. Lalit Verma Sr. Consultant, Centre for Sight
6) Dr. Alka Sachdev CEO, Centre for Sight
7) Dr. Avnindra Gupta Consultant, Centre for Sight

The complainant did not present herself before the Delhi Medical Council.

Briefly stated the facts of the case are that Smt. Shefali Biswas, the complainant with history of hypertension and diabetes and Arthritis underwent left Eye SICS with PcIoL under local anaesthesia on 25.4.2007 at Safdarjung Hospital, New Delhi. The surgery was performed by Dr. Lopamundra Sarkar. It was a day care procedure. After the procedure the complainant was asked to follow up in OPD on next day i.e. 26.4.2007. On 26.4.2007, as per medical records, the complainant operated left eye was found to be fine and she was advised appropriate medication. She was also referred to a medical
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specialist since she was not feeling well. On 28.4.2007, the patient was noted to have developed infection in the operated eye and was advised to undergo vitro retinal surgery. However, since Safdarjung Hospital does not have the facilities of vitro retinal surgery, the complainant was referred to Central Government approved / recognized Centre – Centre for Sight, Safdarjung Enclave, New Delhi since complainant was a CGHS beneficiary. The complainant was not administered any treatment at Centre for Sight. The complainant was subsequently admitted at AIIMS where she was diagnosed as a case of left post operative Panopthalmitis.

It is the allegation of complainant that subsequent to undergoing cataract surgery on 25.4.2007 at Safdarjung Hospital, she developed post surgical complications, due to failure on the part of doctors of Safdarjung Hospital to provide post operative care. Dr. Lopamundra Sarkar and Dr. Anuj Mehta, Sr. Eye Specialist, Safdarjung Hospital in their joint written statement averred that in the month of February 2007, the complainant was seen by Dr. Lopamundra Sarkar in the hospital and was advised cataract surgery in the left eye, under Guarded Visual Prognosis (GVP) since she was suffering from diabetics and hypertension and arthritis. The complainant was advised to go for all the requisite tests such as Urine, Blood Sugar, Blood Pressure, ECGs, Serum Electrolytes, LFT, KFT, ECHO Cardiography before surgery and furthermore pre anesthetic check up was also done in her case as special precaution because she was suffering from diabetics, hypertension and arthritis. After going through the reports of all these test which was found to be satisfactory to carry out an operation a date was fixed for operation i.e. on 25.4.2007 and on the same day the surgery was carried out as a day care procedure which is a system followed by all major ophthalmic centres all over the world and in India also. As per the normal practice of the hospital authority, on the date of surgery the patients have to wait in the air-conditioned recovery room before being taken to the operation theater. The recovery room is within the operation theater premises where the patients and doctors are in OT clothes. There are no infectious items there in the operation theater premises as the sanitary aspect of patient care has been given tremendous care by the administration and a new action plan also was designed to revamp and re-orgnise the entire working process of sanitation by Zonalization, effective supervision and seeking co-operation from paramedical and other supervisory departments. The regular scrubbing and cleaning of floor is done based on scientific method and proper transportation of Hospital waste is being done. The surgery was conducted by Dr. Lopamundra Sarkar deligently under all care of anesthetics under al aseptic precautions. After successfully completion of surgery the complainant was
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again shifted to the air-conditioned recovery room and her blood sugar was checked post operatively since she was a diabetic patient which was found to be normal. Since the cataract surgery is a day care procedure after consulting the senior anesthetist and being advised to take medication and other precautions the complainant was allowed to go home and advised to come up for review on the next day. On 26.4.2007 the complainant came to the hospital but did not complain of any pain. She was procedurally checked and found to be OK. Therefore she was advised for change of pad and all other medications. Since she was not feeling well therefore she was referred to the Medical Specialist which she did not follow. On 27.4.2007 the complainant did not visit the hospital. On 28.4.2007 the son of the complainant rang the doctor on cell phone saying that the complainant’s eye was watering, therefore, the doctor advised to bring her to the hospital. After examining the complainant, it was found that there was infection therefore she was immediately advised for admission, IV antibiotics, eye drops and BP/blood sugar monitoring. The doctor called the Unit Incharge, Head of Department, retina specialist and ultrasonography was done and it was decided that vitro retinal surgery is required. That since the Hospital does not have the facilities of VR surgery the complainant was referred to a Central Government approved / recognized centre i.e. Centre for Sight where CGHS patient are not required to pay anything. The surgeon has acted in accordance with the practice accepted as proper by a responsible body of medical men skilled in the particular art, therefore, she can not be held guilty of negligence and furthermore no sensible professional would intentionally commit an act of omission which would result in loss or injury to the patient as the professional reputation of the person is at stake.

The Delhi Medical Council observes that post operative Endophthalmitis is a known complication after cataract surgery and risk of such complication is higher in diabetic & arthritis patients. Reasonable degree of care has been taken by the treating surgeon; even the case was operated under supervision of Anaesthetics. Cataract surgery being a day care procedure does not require admission in the Hospital. The patient was referred to CGHS recognized centre for vitreo retinal surgery as the facility for same does not exist at Safdarjung Hospital.

It is also alleged by the complainant that she was refused treatment at Centre for Sight. The Medical Superintendent, Centre for Sight in his written statement averred that the patient presented to Centre for Sight with severe pain. On examination vision was PL+ patient had corneal abscess with hypopyon. There was no glow. A diagnosis of post operative endophthalmitis with corneal abscess was made.
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Treatment options and multidisciplinary (eye and systemic) approach was discussed with patient’s relative. Since patient had already received the required Emergency medication and needed a multidisciplinary approach like penetrating keratoplasty which is only possible where eye bank facilities are available, so in the best interest of the patient she was referred to the apex referral centre. Dr. R.P. Centre, AIIMS for further management which is at 10 minutes distance from Centre for Sight.

In view of the above, it is the decision of the Delhi Medical Council that no medical negligence can be attributed on the part of Dr. Lopamundra Sarkar of Safdarjung Hospital in the treatment administered to the complainant at Safdarjung Hospital. We, however, find it very disconcerting that Safdarjung Hospital has not been exercising due diligence in maintenance of records especially with regard to recording the addresses of the patient who undergo cataract surgeries as OPD patients. The Delhi Medical Council, therefore, direct the Medical Superintendent, Safdarjung Hospital to take note of this lapse in record keeping and ensure all relevant information of the patients who are operated as OPD / Day care surgeries is maintained by the Hospital.

Complaint stands disposed.
By the Order & in the name of
Delhi Medical Council



(Dr. Girish Tyagi)
Secretary
Copy to :-

1) Mrs. Shefali Biswas, W/o. Lt. H.N. Biswas, R/o. H-1/21, Mahavir Enclave, Bengali Colony,
Palam, New Delhi – 110045

2) Medical Superintendent, Safdarjung Hospital, Ansari Nagar, New Delhi – 110029

3) Dr. Lopamudra Sarkar, Through Medical Superintendent , Safdarjung Hospital, Ansari Nagar, New Delhi – 110029

4) Medical Superintendent, Centre for Sight, B5/24, Safdarjung Enclave, New Delhi

5) Addl. Secretary, Medical Council of India, Pocket-14, Sector-8, Dwarka, New Delhi – 110077 – with reference to letter No. MCI-211(2)(22)/2008-Ethics/10627 dated 17.9.2008

6) Director General Health Services, Office of Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, Nirman Bhawan, New Delhi – 110001 – for information & necessary action.



(Dr. Girish Tyagi)
Secretary