Avoid 'Adventurism' or Acting outside the accepted medical practice
The patient, aged about 34 years, was suffering from hypermetropia and was using spectacles of plus 9.5. The patient was hospitalized, consent was taken, and Radial Kera Diathermy (RKD) was performed by the ophthalmologist (OP). About eight months later, as there was no improvement, the patient again approached the ophthalmologist (OP) who had performed Photorefractive Keratotomy (PRK) in both the eyes. Thereafter, a third surgery, that is, PRK was repeated in both the eyes. A month after the third surgery the patient consulted another hospital where he was diagnosed with 'Central Corneal Opacity Macular'. A month thereafter, the patient consulted yet another eye center, wherein, it was reported that the corneal haze was growing day by day. The patient thereafter consulted AIIMS, where he was advised to undergo a corneal transplant.
A panel of four doctors from AIIMS reviewed the patient's record and gave their opinion to the court stating that the ophthalmologist (OP) was wrong for operating both the eyes, as the same was not done in case of hypermetropia and that RKD was not the correct method for correction of hypermetropia.
It was alleged that the ophthalmologist (OP) had assured the patient that the spectacles could be removed after a minor surgery and that the ophthalmologist (OP) had cured hundreds of such cases, but even after three surgeries the patient did not get the relief of removal of spectacles.
- The court observed that as per the AIIMS report there was no literature available to support that RKD was the correct method for correction of hypermetropia and further observed that this was the ophthalmologist's (OP) own invention. The court termed this as 'adventurism' and held that this was not the accepted medical practice;
- It held that the ophthalmologist (OP) had failed to inform the pros and cons of the surgery to the patient, especially the fact that corneal haze is a well-known side effect of PRK surgery. The court held the ophthalmologist (OP) negligent for failure to perform the requisite investigations;
- It observed that the ophthalmologist (OP) was giving a fragile excuse of having given all the medical records to the patient, as he was supposed to maintain complete records of all the three surgeries and held that this suppression of records was by itself negligence;
- Every medical act must be within the parameters of the accepted medical practice, something that is recognized by authoritative medical texts and literature and acceptable to the medical fraternity. (In this case, the ophthalmologist's (OP) claim that Radial Kera Diathermy (RKD) was the correct treatment for hypermetropia was not supported by medical literature. The court held the ophthalmologist (OP) negligent as he had not acted in accordance with the 'accepted theories'. The court termed this as 'adventurism' observing that this was the ophthalmologist's (OP) "own invention, which is not recognized by any accepted literature");
- Investigation reports or the opinion of another doctor obtained by the patient even without your knowledge or advice must be duly recorded in the patient's medical records. Moreover, this should neither be taken as a personal insult nor should one react violently. (In this case, the patient alleged that he showed the report of another doctor to the ophthalmologist (OP), who simply rejected the same, stating that such reports are baseless and have no meaning. Later on the diagnosis of the said report was confirmed);
- Doctors and hospitals are legally required to keep the original medical records of the patient and handing over the same to the patient is not a valid excuse in the eyes of law. (In this case, the court rejected the defense of the ophthalmologist (OP), who stated that he had given all the original medical records to the patient. The court termed this as 'specious plea' and 'fragile excuse' and further observed that, "The suppression of the record by the doctor (OP) itself speaks volumes of the negligence on the part of the doctor (OP)");
- The patient must be duly informed about the advantages and disadvantages, risks and complications associated with a procedure / surgery / treatment in terms that can be comprehended by the patient;