Experience cannot compensate for expertise

  • Posted on: May 04, 2023

The patient was under obstetrician’s regular antenatal (ANC) care. Over a period of over six months or so, the doctor had performed USG seven times. There were no abnormal findings in any USG.

The patient delivered a baby girl, but unfortunately, she was born with congenital abdominal wall defect. The new-born was referred to another hospital. She was taken to yet another hospital from the referred hospital where she died after a day.

The parents were heartbroken and devasted by their loss. They sued the obstetrician and alleged that she was neither qualified to perform USG nor consulted a radiologist who could have detected the congenital anomaly on time.

The obstetrician vehemently opposed the allegation, stating in defence that the foetus’ position was breech and hence it was very difficult to detect its front / abdominal position. It was further stated that due to USG’s technical limitations, congenital anomalies can’t be detected every time because of gestation period, foetal position, quantity of liquor, etc. The subtle defect may not be seen in all scans.

The Commission did not agree with doctor’s defence, while making following observations:

“It is evident from the record that the obstetrician performed seven USGs during ANC follow-ups including target scan (level II) at 18 weeks and 1 day. It was breach presentation, but in our view, anterior abdominal wall defect during the target scan shall not be missed as it could be easily visible”.

“The ultrasound scan is done every four weeks to measure the foetal biometry. It is to monitor foetal growth and amniotic fluid. It is best to monitor growth through estimation of foetal weight by the Siemer formula, which uses biparietal diameter, occipitofrontal diameter and femur length, rather than formulas using abdominal circumference. Thus, the detection of congenital anomalies needs expertise, training and competency in radiodiagnosis”.

“No doubt the obstetrician possesses thirty years of experience in obstetrics, the question before us is if she was competent enough or failed in her duty of care to report the target scan – (level – II USG) which detects development and position of the foetal organs. The abdominal wall defect could easily be detected irrespective of breach presentation. In our view, any radiologist of ordinary prudence could have detected such abnormality and it could have averted the patient’s sufferings. She could have aborted the baby within twenty weeks of pregnancy”.

“Based on the discussion above, it was neither a bona fide mistake nor an error of judgment by the obstetrician, but it was failure of duty of care during the target scan (level-II)”.

The doctor was held negligent for aforementioned reasons, and ordered to pay compensation.

Source: Order pronounced by National Consumer Disputes Redressal Commission on 9th January, 2023.