Medical protocols must be clear and uniform with little scope for confusion or individual misinterpretation. When protocols are left to individual interpretation, both doctors and patients are bound to face problems as demonstrated in this case.
Irrefutable Facts
The patient underwent angiography (CAG) at the hospital which reported ‘RCA: DOMINANT, PROXIMAL MILD DISEASE, GOOD DISTAL VESSEL PDA.’
The cardiologist advised medical management. After 5 months, the patient suffered a myocardial infarction (MI) and consulted a second cardiologist at another hospital who performed an angiography which revealed 99% blockage of the LCA.
The patient underwent a successful Coronary Artery Bypass Graft (CABG) surgery.
The second cardiologist reviewed previous angiography report and opined that ‘the coronary angiogram report issued by the first hospital was absolutely wrong and they have not properly gone through the film.’
An affidavit was also filed by this cardiologist on similar lines.
Patient sued the first hospital and first cardiologist. It was alleged that the doctor failed to diagnose the lesion of 75% stenosis and the LV dysfunction, which led to further health deterioration and the need to undergo CABG later.
Court’s Observations
The court after perusing medical records and medical literature observed that “at the time of admission, the patient was asymptomatic and the chest was clear” and therefore the cardiologist took a conscious decision of medical management, prescribed proper medication and called the patient for review.
The court further observed that “the treating doctor has to decide which treatment is more beneficial for the patient” and held that the treatment advised by the first cardiologist was not a deviation from the reasonable standard of practice.
The court further observed that “in the larger interest of patients in our country, the angiography reporting should be uniform. Many times, it was noticed that findings in CAG reported as mild / moderate or severe stenosis’, which is an individual cardiologist’s perception, and it varies from person to person. Thus, to decide for better patient care and management, it would be proper to report the CAG as type (A, B, C) and grading the percentage (%) for coronary occlusion / block as many institutes follow the American College of Cardiology / American Heart Association (ACC / AHA) Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures who developed a classification scheme to characterize the complexity of coronary stenosis”.
Furthermore, the court commented harshly on second cardiologist’s opinion about first angiography report.
“Giving mere unreasoned, unelaborated value judgement or making remarks of this nature on other similarly / equally qualified consultant(s) is unethical and not viewed favourably. It appears to be sponsored litigation.”
Patient’s case against the first hospital and first cardiologist was dismissed.
Prevention Is Better Than Cure
There may be more than one way of treating / managing a condition. A doctor following any one of the accepted medical practices is not negligent although there may be other doctors who would have preferred another option.
Source : Nizam’s Institute of Medical Sciences v/s S. Ramakrishna through Lrs. & Anr.
Get 7 days online access of this case’s abstract and its complete judgment for INR 250
Subscribe to this Case