In absence of clinical symptoms, doctors can’t be held accountable for complications

  • Posted on: March 21, 2024

The patient, an alcoholic, was admitted to the hospital with complain of upper abdominal pain. CT scan was performed; it reported pancreatitis and a small area of necrosis at the neck of pancreas.

During his stay at the hospital, the patient complained of food particles stuck in throat, therefore, esophagogastroduodenoscopy (EGD) was performed. He was discharged after six days.

After about seven months, the patient was readmitted with complains of severe upper abdominal pain. CT scan was performed; it reported mass in pancreas, but it was inconclusive. He was discharged after seven days.

The patient consulted another hospital where advanced pancreatic cancer was diagnosed, which was confirmed by two other hospitals where patient was admitted. He was readmitted at the first hospital, but the cancer was in an advanced stage. He sought DAMA, and eventually died few days thereafter.

His family laid the blame upon first hospital, the gastroenterologist who treated the patient and the radiologist who performed CT scans. It was alleged that:

  1. The gastroenterologist ignored radiological findings of necrosis and did not suspect that the dead cells could be cancerous
  2. The radiologist made two arrow marks on the film to indicate two small tumours that eventually developed to non-resectable adenocarcinoma
  3. The doctors and hospital violated national and international guidelines on diagnosis and treatment of pancreatic cancer
  4. They doctors did not perform biopsy and other tests to confirm pancreatic cancer, and they did not seek opinion from other senior doctors either

The doctors and hospital denied every allegation. They presented medical records and treatment charts to prove their innocence.

The Commission perused the documents thoroughly, and observed the following:

“From the medical records, it is evident that the patient was diagnosed as acute mild pancreatitis with necrosis at the neck of pancreas the first time. The CT scan films were reviewed by two radiologists. The pancreas appeared to be swollen with suboptimal parenchymal enhancement, particularly in the body and tail, and a small area of necrosis was noted at the neck of pancreas. It is pertinent to note that the patient had difficulty in swallowing solid food, but there was no abdominal pain or loss of weight. The EGD showed erosive gastritis and the patient was called for review if the symptoms recurred”.

“After seven months, the patient again underwent CT of abdomen, which showed mass in the body of pancreas adherent to porto-mesentric confluence, celiac and common hepatic artery. The patient underwent endoscopic ultrasound guided FNAC which was inconclusive due to scanty sample. We further note that the patient, after being discharged from the hospital, was periodically hospitalised in different hospitals. Then he came back and got readmitted, but by that time he was in advanced stage of cancer. He was in shock with kidney failure. The poor prognosis was explained. The patient sought DAMA and died few days later”.

“The initial clinical presentation, age of the patient, history of alcohol consumption along with negative history of diabetes mellitus as well as radiological imaging of the patient are consistent with the diagnosis of mild acute pancreatitis, and there were no symptoms or any radiological findings that were suggestive of possible pancreatic malignancy at that point in time”. 

The case against hospital and doctors was dismissed by the top consumer court.

Source : Order pronounced by National Consumer Disputes Redressal Commission on 1st June, 2022.