The dire need of standardizing angiography reporting

  • Posted on: April 28, 2022

In this remarkable case, the Court has made two important observations. First one in interest of patient safety & patient care, and second one in the interest of healthcare providers. The Court has observed that angiography reporting should be uniform across the country and a doctor giving value judgement or opinions on other doctor’s reporting is unethical.

The patient was admitted to the hospital where he underwent angiography in the month of February. There were no symptoms of a heart ailment and his vitals were normal. The doctor decided to medically manage patient’s complaints of chest pain and prescribed medication.

Sometime in month of July, the patient suffered heart attack and was taken to another hospital where the cardiologist reviewed angiography report and opined that there was 75% critical lesion. Another angiography was performed at this hospital which reported 99% critical lesion.

Eventually the patient underwent CABG and was discharged after some days.

The cardiologist at the second hospital had submitted a written opinion before the patient was discharged. “I respectfully submit that at the time of patient’s visit to the first hospital, his health condition was in such a state where proper treatment and medicines could have cured him and no surgery was required. But the improper diagnosis by the doctor has led to further deterioration of patient’s health and it went to a stage where he had no other option except to undergo CABG”.

The patient blindly believed in this opinion, sued the first hospital and its doctor alleging negligence.

The Commission perused medical records and observed that the patient was asymptomatic and his vitals were normal and hence the doctor took conscious decision to manage his condition medically.

The Commission seemed unimpressed with cardiologist’s opinion as it stated the following:

“I do not readily accept comments of the cardiologist that angiogram report issued by the hospital was absolutely wrong, not proper and they have not properly gone through the film. In my view after going through the angiography films he should have made his own speaking report. Giving mere unreasoned, unelaborated value judgement or making remarks of this nature on other similarly / equally qualified consultant is unethical and not viewed favourably. It appears to be sponsored litigation”.

The Commission also made an important observation on standardizing angiography reporting across the country, stating the following: “In larger interest of the patients in our country, angiography reporting should be uniform. Many times, it was noticed that findings are reported as mild / moderate / 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 it 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 Task Force on assessment of diagnostic and therapeutic cardiovascular procedures who developed a classification scheme to characterize the complexity of coronary stenosis”.

The patient’s case against first hospital and its doctor was dismissed, however, these two observations could be cited as benchmark in some other future litigations.

Source:Order pronounced by National Consumer Disputes Redressal Commission on 15th December, 2021.