Rule out complications – That’s the rule

  • Posted on: November 18, 2021

Does law hold doctors responsible for failing to diagnose a complicated condition? Only if such conditions are known to be missed during diagnosis, and if other tests are not performed to rule them out.

The patient sustained injuries in a road accident and was taken to the hospital. The doctors diagnosed fracture of right thigh bone and performed an operation for intramedullary nailing of shaft femur. However, the patient experienced unbearable pain in the leg thereafter, and visited another doctor.

X-ray performed by this doctor revealed fracture of loin bone and advised him to approach the hospital. Doctors at the hospital advised him to undergo bone grafting as there was no union of bones. But the patient denied it due to financial constraint. He eventually went to a government hospital where another procedure was performed.

The patient sued the hospital and alleged that X-ray taken before the operation did not show any intra capsular fracture of neck femur. However, the X-ray taken after post-operation, that too within twenty four hours, clearly revealed the same and moreover, the doctors failed to detect intra capsular fracture neck femur even during follow-up visits.

The doctors and hospital, of course, denied these allegations.

The Commission saw merit in patient’s case and after going through medical records and medical literature, stated the following:

“We find that the operation for intramedullary nailing of shaft femur was performed without any fault by qualified orthopaedic surgeon. However, failure to take appropriate X-rays with external rotation of the shaft of femur to rule out the presence of a sub-clinical occult fracture may account for pre-operative misdiagnosis”.

“It is important to understand that patients, especially poly-traumatized ones, whose femoral shaft is fractured, highest level of suspicion must be maintained for concomitant presence of an ipsilateral femoral neck fracture. This would help reduce incidences of a missed femoral neck fracture”.

“An error of judgment / failure to make diagnosis of a complicated condition by itself does not amount to negligence, but it can be said that missing fracture neck femur which normally is missed in 50% cases, is an act of negligence”.

The hospital and doctors were held negligent for not adopting diagnostic techniques to confirm presence of ipsilateral femoral neck fracture.

Source: : Order pronounced by National Consumer Disputes Redressal Commission on 8th July, 2021.