Diagnostic errors pros and cons – Effect on patient’s health – Applicability of Indian laws – Case study


C.L. Avadhani

Research Scholar, (Ph. D) Annamalai University

Phone number: +91-94414 75465

Email ID: avadhanichalla@gmail.com


Diagnostic Errors are more common but at times they are fatal.  According to W.H.O, Global health service is to provide healthcare to people who are unwell and to assist them to bring them to normalcy.  Though in majority of the countries health service professionals work hard to provide safe and high quality healthcare, but sometimes the patients are inadvertently harm.  This kind of unsafe healthcare has been recognized as a global challenge and much has not been done to understand the process, consequences and available solutions to the problem. Diagnosis is one of the most important tasks performed by healthcare providers.  Diagnostic errors can lead to a patient harm from wrong diagnosis, delayed diagnosis, missed diagnosis etc., Corrective and timely diagnostic errors relies on many factors including knowledge, experience and skill.  Diagnosis is high risk area for errors.   Diagnostic errors are costly and harmful than treatment errors. The researchers of John Hopkins Hospital while looking into 25 years of US Malpractices and claim payouts observed that Diagnostic errors accounted for large payouts than surgical medication and such other mistakes. 

What is Diagnostic Error?

IOM has defined quality of care as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge“(IOM 1990 Page 5).  

The IOM report “crossing the quality chasm” further elaborated on high quality care by identifying six aims of quality. “Healthcare should be (i) safe – avoiding injuries from care i.e., intended to help them; (ii) effective – giving healthcare services with scientific knowledge to those who could benefit and not to provide to those not likely to benefit; (iii) patient – centered – providing care to individual preferences, need, and values and ensuring that patient values guide all clinical destination (iv) timely – to reduce delays that are harmful for the patient as well as healthcare professional (v) efficient – to avoid unnecessary ideas, waste of time, waste of using unnecessary equipment etc., (vi) equitable – healthcare should not vary in quality with respect to personal characteristics, gender discrimination, ethnicity, geography and socio economic status” (IOM 2001 Page  6).  Accurate timely diagnosis is important for providing quality care, otherwise errors leads to major threat to quality care.  

IOM defines an error in medicine to be the “failure of planned action to be completed as intended (i.e., error of execution) and the use of a wrong plan to achieve aim (i.e., error of planning) (Commission)” (IOM 2004 Page 30). The definition also recognizes the failure of an unplanned action that should have been completed (Omission) as an error.  (IOM 2004).  The IOM report,

There are four types of errors, viz., Diagnostic, Treatment, Preventive and Adverse.   

An unintended harm to the patient by an act of commission or omission is called an adverse event (IOM 2004 Page 32).

According to Mr. Graber and Colleagues, diagnostic error is defined as, an unintentionally delayed, those sufficient information is available, wrong i.e., a mistake made before correct one, no diagnosis made. 

They also divided into three main categories (i) No Fault Error, (ii) System Related Errors and (iii) Cognitive Errors.

According to Chimowitz et al, 1990, each of these errors can occur in isolation but they often interact with one another; for example systems factors can lead to cognitive errors.

Schiff and Colleagues 2009 Page 1882 defined Diagnostic error as “any mistake or failure in the diagnostic process leading to a mis diagnosis a missed diagnosis or a delayed diagnosis”.  They divided the diagnostic process into seven stages (i) access and presentation (ii) History taking / collection (iii) the Physical examination (iv) testing (v) assessment (vi) referral  and (viii) Follow up.  A diagnostic error can occur in any stage in the diagnostic process, and there is a spectrum of patient consequences related to these errors ranging from no harm to severe harm. They also said that not all diagnostic process errors will lead to a missed, delayed or wrong diagnosis and not all errors. (either in the diagnostic process or related to mis diagnosis) will result in patient harm.

In describing Diagnostic Error Singh 2014 Page 99, he said on defining missed opportunities, where a missed opportunity “implies that something different could have been done to make the correct diagnosis earlier……”.

Centered Diagnostic Error is

The failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient

A diagnosis is considered wrong when it is inaccurate, incomplete (it does not represent patient’s condition or does not reveal enough treatment for optimal treatment) or is determined too late to guide effective treatment decisions.

1. Missed Diagnosis: When a diagnostic test do not provide an explanation for a patient’s complaints (common in patients with chronic factic or chronic pain).

2. Wrong Diagnosis: The original diagnosis is found to be incorrect because misidentification of nature of disease.

3.  Delayed Diagnosis:  Time delay in identifying the error.

4. Failure to recognize complication:   It meansthough the Doctor identifies right diagnosis, but could not identify the complications that arise subsequently and aggravate illness.

5. Failure of diagnosing related disease:   At times, the Doctor diagnosis one disease and fails to diagnose a related disease which goes hand-in-hand with the primary condition or that has higher risk of incidence in patients with primary disease. 

6. Failure to diagnose an unrelated disease:   A Doctor failing to unrelated second disease though he diagnosis one disease correctly.

Following are few examples:

  • Cancer:  It is an illness that can present common symptoms, cancer is the most misdiagnosed disease.  Accordingly to General of Clinical Oncology, Doctors may miss or misdiagnose certain types of cancers upto 44% of the type.
  • Heart Attack:  Often mistaken for anxiety or indigestion, a cardiac episode can be deadly without timely treatment.   It is the responsibility of patient’s also to have a second opinion if they have doubts about their heart condition. 
  • Depression:  Unfortunately many medical professionals lack the training needed to properly diagnose and treat mental illness.  It is quite normal of the medical professionals with a mistaken notion dismiss the illness as a mood or phase with depression which is ultimately not. 
  • Stroke:  Sometimes even the experienced physicians may overlook the symptom of a stroke because they are common. In particular young people may be discharged early from the hospital because their stroke symptoms were misdiagnosed as vertigo, intoxication or a migraine.
  • Fibromyalgia:   Some medical conditions have symptoms that mirror those off more common illnesses.  Because it can cause joint pain, fatic and muscle aches, fibromyalgia is often mistaken for rheumatic diseases like lupus, chronic fatic syndrome and rheumatoid arthritis.
  • Celiac Disease:  “About 83% of people the celiac disease are either still undiagnosed or have been misdiagnosed with other conditions” according to Rachel Begun MS RDN.  The reason is the symptoms for celiac disease are many and vary widely from person to persons.  The symptoms commonly include abdominal pain, constipation and diarrhea; But people may experience takes joint pain or depression. Celiac Disease is most often misdiagnosed as irritable bowel syndrome.
  • Lyme disease:   A bacterial infection caused by a tick bite, Lyme disease can cause symptoms like muscle and joint pain, fever, stiffness and fatigue.   The primary symptom is a rash but not everyone develops one.  On average people struggle for one to two years before they are accurately diagnosed with Lyme disease.  
  • Thyroid Conditions:  A common cause of hormonal imbalance, thyroid disease can bigger production of too much thyroid hormone (Hyperthyroidism) or too little hyperthyroidism.  Unbalance level of Thyroid Hormone can cause symptoms such as weakness and fatigue, fluctuations in weight and muscle pain.  If these symptoms are mild they can be mistaken for other conditions such as depression.
  • Aortic Dissection:   When there is a tear in the wall of the aorta, blood rushes through and forces layers of aorta to separate.  This type of symptoms are also found in other different ways and can be misleading and confusion to the doctors causes delay in recognizing the same is at times fatal. 
  • Pulmonary Embolism:  It is caused by a blood clot in the pulmonary artery, which carries the blood to the lung.  A patient sometimes gets sharp chest pain, shortness of breath, fainting and anxiety.  Here the doctors many a times mistaken these conditions for diseases such as Heart Attack and Pneumonia. 

Missed and Misdiagnosis can happen to anyone – and they do:  Here are the some of the examples.  The well known and respected Doctor JEROME GROOPMAN wrote a book “How doctors think” after being misdiagnosed many times.  FRAN DRESCHER, known as T.V.’s The Nanny and Padmalakshmi the host of the T.V. show, Top chef, were both misdiagnosed over and over again before finally learning what their medical problems were and what treatment could actually work.  They are lucky because they got right diagnosis in the second time.

Misdiagnosis and Delayed Diagnosis:  These types of diagnosis attract law suits causing patient harm and at times fatal is a cause of concern.  The doctors can be brought to the court only when the diagnostic error is to be proved by the patient and that it caused harm.   The ingredients are

  1. There should be a Doctor patient relationship when the incident occurred
  2. Doctor is negligent
  3. Doctor negligence in diagnosis is the cause of injury to the patient.

The main element is whether the Doctor evaluated diagnosis with due diligence or not.  It means the Doctor should take all precautions in arriving a decision of diagnosing the ailment and the procedure to be adopted. 

Errors in Diagnostic Test:  Sometimes a Doctor fails to correctly diagnosis a condition because he relied on in accurate results from the laboratory tests, radiology films, or other types of tests.  This is due to,

1.         Faulty Equipment

2.    Human error occurred – as an example the samples were contaminated or mixed up or the technician used improper procedure or the test results were incorrectly read or the technician or specialist missed something in the X ray or Pathology.

It is the duty of the patient to prove the doctors negligence in any form of diagnosis mentioned above causing injury to the patient or slowing down the progress due to diagnostic errors.  As an example, a delayed cancer diagnosis will cause irreparable loss to the patient and at times it becomes fatal.  In a rare case a Doctor diagnosis a patient with a condition or illness that the patient does not have the patient may also be able to prove harm in the form of anxiety, stress medical problems and expenses due to unnecessary treatment.

Finally a doctor can be sued for negligent act due to failure to diagnose, and failed to treat the patient with a standard of care because of diagnostic errors.  In addition the patient should prove that provider breached a standard of care and that breach caused injury to the patient (causation). Finally the injury should be substantial and caused full or partial damage to the health and earnings of the patient.

MISDIAGNOSIS IN THE EMERGENCY ROOM:

The incidents of errors of misdiagnosis are much higher in operation theaters and ICUs.  This is due to work load that causes no time to investigate clearly and differentiate the diagnostic mistakes also the complications that arise in the emergency room in the given situation the Doctor has to take incident decisions which may go wrong.  As an example, a woman patient experiencing gastric problem is diagnosed with Heart Attack. Common conditions of misdiagnosed in emergency rooms include, heart attack, stroke, pulmonary embolism and meningitis in addition to misdiagnosing of appendicitis.

Diagnostic Errors are more likely the consequences of the complexity of diagnosis and healthcare delivery, and they call cognitive error (basic human mistake). Most malpractice claims for diagnostic error involved heart attack, cancer, or stroke.  The delay in diagnosis of breast cancer is also very common.

The consequences of diagnostic error

The case for reducing diagnostic error intensifies when healthcare organizations realize how common it is. 

Failing to diagnose correctly can lead to unnecessary suffering.  Failure to provide treatment or provide incorrect treatment means that both types of medical mis diagnosis carry potentially life threatening risks.  Certain types of surgical negligence that includes, wrong operation being performed, wrong body part being operated, foreign objects left in the body, organs being perforated, cosmetic surgery causing scaring and disfigurement, infection caused by pure hygiene.

Prescription and Medication Errors are common now-a-days.  Taking the wrong medication or an incorrect dose of medication can have serious consequences including brain damage, allergic reaction, digestive problems, psychological illness, in some cases even death.  These are due to wrong prescriptions dispensed some prescriptions, incorrect dosage or incorrect length of medication and advising medication that are allergic to the patients which are normally due to diagnostic errors from missed or misdiagnosis.  

A NAM report in 2015 discloses growing concern of diagnostic errors which are causing damages clinically and financially.  The report also says efforts should be made to identify and monitor and reduce such errors which can be minimized if not eliminated fully.

According to Bryan Oshiro, M.D.,

To get (the diagnosis) right, and to get it right the first time is one of the greatest challenges in the healthcare.  It is more important now than ever before due to the complexity and cost and available cures and treatments today“.  

Accurate timely diagnosis helps ensure patients receive the most appropriate care.  Health Systems that prioritize diagnosis process improvements more the patients efficient use of resources and tests and ensure the correct diagnostic procedures and protocols are used.

Why diagnostic errors happen?

According to a report from Institute of medicine (IOM) the following reasons are cited

1.    Lack of Communication and Corroboration between clinicians, patients and family members

2.         Flaws in the healthcare work system that do not support the diagnostic problems

3.         Lack of Feedback for clinicians about the diagnosis they select and

4.         A culture that discourages transparency and disclosure of any diagnostic errors

How to stop Diagnostic Errors?

Following are the suggestions made by IOM to Hospitals to minimize the diagnostic errors. 

  1. There should be coordination between diagnostic process and clinical staff patients and their families, since patient and their families are having more knowledge about the ailments that helps to get informed diagnosis. 
  • Continuous education and training to all the concerned and updating the knowledge to minimize the diagnostic errors. 
  • Introducing IT support in healthcare process to minimize diagnostic errors.
  • A broadly accepted procedure of maintaining electronic health records. 
  • Implementation of the system that recognizes diagnostic errors and steps to correct and prevent them. 
  • A systematic procedure with the help of a well developed software at every important places to eradicate diagnostic errors. 
  • Creating a work culture designed support the diagnostic process and improvement when and where is required. 
  • A systematic development of reporting environment at every stage with better communication, improving diagnosis system through learning from errors. 

Victor J. Diuzou M.D. President U.S. National Academy of Medicine, mentioned under the following title.

Diagnostic error: under recognized problem

1.    Patient safety beyond the hospital:  The majority of patient safety efforts have focused on medical error in hospitals

2.    Improving Diagnosis:  It is likely that most of us will experience atleast one diagnostic error in our lifetime, sometimes with devasting consequences.  This is because (i) Failure to establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to that patient

Patient Experience with Diagnostic Error:

  1. Physician failed to explain that aspirin is present in many medicines. The test results were incorrect.  Then patient reported that she had taken a medicine (Alka-seltezer) within the past 24 hours which contains aspirin.  This result repeat performance of test. 
  • Where failures in diagnostic process occur:

            a.         Failure of engagement  

            b.         Failure in information gathering

            c.         Failure in information integration

            d.         Failure in information interpretation

            e.         Failure to establish an explanation for the health problem

            f.          Failure to communicate the explanation

  • Minimizing diagnostic errors: 

            a.         Be Reflective.  Take a diagnostic time out

            b.         Listen, really listen to your patients and their caregivers

            c.         Learn the causes of cognitive errors and how to avoid pitfalls

            d.         Do not trust your intuition – always construct a differential diagnosis

            e.         Take advantage of second opinion

            f.          use diagnosis – specific decision support resources

g.    Make the patient your partner in diagnosis: Ensure they know how to get back to you if symptoms saying or persist

h.    Ensure all ordered diagnostic tests and consults are completed and that you         know the results:  Designate a surrogate to review test results if you planned to away.

i.     Speak directly with the staff providing you with a diagnostic test results: Radiologists, Pathologists, Clinical Pathologists.  If you are not sure of the      most appropriate diagnostic strategy, ask, or use, online test ordering advice.

j.     Empower your colleagues if they become aware that a diagnosis will made has changed

Here are some of the decided cases by the Apex Court, National Consumer Disputes Redressal Commission etc.,

1.         State Of Haryana & Ors v. Bala Devi – SC 25-01-2008

…a finding that the deceased Randhir Singh was suffering from heart disease, that due to a wrong diagnosis, he was treated for tuberculosis and as a consequence he died due to heart disease. The High…complications. The High Court has held that the wrong diagnosis and failure to treat the deceased for heart disease should be treated as criminal negligence on the part of the State of Haryana and the Prison…diagnosis and wrong treatment during the period when the deceased was in judicial custody cannot be considered as a criminal negligence on the part of the jail authorities. The deceased had been referred…

2.         Kusum Sharma And Others v. Batra Hospital And Medical Research Centre And Others

            SC – 10-02-2010

…visited Mool Chand Hospital on 10-12-1989 but no diagnosis could be made. Indian Oil Corporation referred him to Batra Hospital on 14-3-1990 where he was examined by Dr. R.K Mani, Respondent 2 and Dr. S…work up re hormonal status and CT head scan.” The same day Dr. R.K Mani referred the case to Dr. C.M Batra, Endocrinologist and sought Dr. Batra’s opinion on the diagnosis…assays had been received, Respondent 2 came to a confirmed diagnosis that Shri R.K Sharma had a secreting adrenal tumour. The patient was informed that surgery for removal of an adrenal tumour was planned…

3.         VINOD JAIN v. SANTOKBA DURLABHJI MEMORIAL HOSPITAL SC – 25-02-2019

…negligence vide impugned order dated 1.8.2017. It was opined that at the highest, it could be termed as a case of wrong diagnosis and certainly not one of medical negligence. 7. In…opined that at best, it could be categorised as a possible case of wrong diagnosis. 16. In our opinion the approach adopted by the NCDRC cannot be said to be faulty, while dealing…: A medical practitioner was not to be held liable simply because things went wrong from mischance or misadventure or through an error of judgment in choosing one reasonable course…

4.         Dr. R. Jairam Iyer v. State Of Chhattisgarh HC – 08-07-2015

…the realm of diagnosis and treatment there is scope for genuine difference of opinion and one professional doctor is clearly not negligent merely because his conclusion differs from that of other…Ashok Pingle had chest pain for which diagnosis of acute coronary syndrome (Non ST – Elevated AMI – Anterior leads) was made. For this late Pingle was given primary invasive line of treatment. Coronary…: Final diagnosis as per Apollo Hospital records is “CAD with acute anterior NSTEMI with post primary PTCA status to LAD and D1 with acute re-infarction with stent thrombosis and Lt. Main Thrombosis with…

Judgments by NCDRC:

5. M. LAKSHMINARASIMHAIAH & ORS. v. MEDICAL ADMINISTRATOR, BANGALORE HOSPITAL & ORS. Date: 29 Sep, 2008

…the State Commission was that the delay of only 45 days between the wrong reporting of the pathological examination by Dr. T.V. Rao respondent opposite party No. 4 and the correct diagnosis of breast…: A wrong diagnosis or error in judgement would not make respondent No.3 & 4 liable in action in view of the authentative pronouncement of decisions of the National Commission and Supreme Court…. It is apparent from this statement that he had made a wrong diagnosis but have been pleading for treating the same to be an error of judgement. We are afraid the contention is not…

6.         RAM CHANDRA RAI v. DR. MD. ZAHEER, Date: 2 Sep, 2014

…. Hence, the second operation performed by Dr. Ashutosh Saran, was not a result of any wrong diagnosis or any negligence during previous operation. We have given our thoughtful…consideration and noted that, Dr. Ashutosh was not summoned before the District Forum. The operation performed by Dr. Ashutosh Saran was not due to result of either wrong diagnosis or negligence in the previous…that the OP doctor committed negligence and deficiency in service in diagnosis as well as in performing the surgery and during post-operative period. The Complainant spent a total sum of Rs.15,000…

7.         DR. R.K. PANDEY, SURGEON v. CHANDRA SHEKHAR PANDEY & 3 ORS, Date: 10 Jul, 2014

diagnosis. Thus, he is responsible for the wrong committed by him. 13. The third point in this Revision Petition is whether the Saraf Hospital is liable? The Counsel for the Saraf Hospital argued that…wrong diagnosis. The OP-3 the Saraf Hospital has limited role in this case; we do not find any lapses or negligence by it. Therefore, with the forgoing discussion, we find there is apparent error in the…due to any negligence , but it was due to an advanced (metastatic) cancer of gall bladder, therefore we restrict and fix the liability of medical negligence on OP-1 for his wrong diagnosis and pass the…

8. SARAF HOSPITAL v. CHANDRA SHEKHAR PANDEY & 3 ORS.  Date: 10 Jul, 2014

diagnosis. Thus, he is responsible for the wrong committed by him. 13. The third point in this Revision Petition is whether the Saraf Hospital is liable? The Counsel for the Saraf Hospital argued that…wrong diagnosis. The OP-3 the Saraf Hospital has limited role in this case; we do not find any lapses or negligence by it. Therefore, with the forgoing discussion, we find there is apparent error in the…due to any negligence , but it was due to an advanced (metastatic) cancer of gall bladder, therefore we restrict and fix the liability of medical negligence on OP-1 for his wrong diagnosis and pass the…

9.         POST GRADUATE INSTIT… v. MAMTA RANI @ BABLI &…, Date: 24 Jan, 2017

…. Counsel for the appellants/OPs argued that the basic issue involved in the present case was whether a wrong diagnosis had been made at the PGI and if it was so, whether such wrong diagnosis amounted to any…] biopsy was not conducted and wrong diagnosis was done, it constitutes medical negligence on the part of the OPs. Further, in Ritu Garg vs. Dr. Vineet Sharma & Anr. [RP No. 2074/2015…, as the tumour had already spread above the knee due to delay in proper and required clinical diagnosis of the tumour at the OP-1 Hospital. The amputation was done on 17.11.2011 on urgent basis and…

10.       JASWINDER KUMAR, THR… v. POST GRADUATE INSTIT…, Date: 24 Jan, 2017

… Counsel for the appellants/OPs argued that the basic issue involved in the present case was whether a wrong diagnosis had been made at the PGI and if it was so, whether such wrong diagnosis amounted to any…] biopsy was not conducted and wrong diagnosis was done, it constitutes medical negligence on the part of the OPs. Further, in Ritu Garg vs. Dr. Vineet Sharma & Anr. [RP No. 2074/2015…, as the tumour had already spread above the knee due to delay in proper and required clinical diagnosis of the tumour at the OP-1 Hospital. The amputation was done on 17.11.2011 on urgent basis and…

11.       DR. VIJAY SINGHAL v. SMT. NEETU SINGH & ANR., Date: 12 Aug, 2014

…the Complainant/Patient regarding wrong diagnosis of pre-eclampsia and also failure to record her case history at the time of her admission. After having perused the medical history recorded at the…time of her admission, we are unable to agree with this contention pertaining to wrong diagnosis of pre-eclampsia because the bed head ticket prepared at the time of her admission clearly states that…a comatose condition. Since her -2- condition was caused because of wrong medical treatment by Opposite Parties, the Complainant/Patient approached the State…

12.       DR. K.K. KABBAR & ANR. v. SMT. NEETU SINGH & ANR. Date: 12 Aug, 2014

…the Complainant/Patient regarding wrong diagnosis of pre-eclampsia and also failure to record her case history at the time of her admission. After having perused the medical history recorded at the…time of her admission, we are unable to agree with this contention pertaining to wrong diagnosis of pre-eclampsia because the bed head ticket prepared at the time of her admission clearly states that…a comatose condition. Since her -2- condition was caused because of wrong medical treatment by Opposite Parties, the Complainant/Patient approached the State…

13. DR. SANJAY J. BATRA v. JAGRUT NAGRIK & ORS., Date: 12 Apr, 2016

…Diagnostic errors comprise a substantial and costly fraction of all medical errors. A wrong diagnosis by a clinical pathologist could lead to delayed or inappropriate treatment and may result in a legal…committed by the pathologist. Because of the complex nature, surgical pathology diagnosis has an appreciable degree of fallibility and is increasingly subject to -1…) report of the specimen revealed no cancer. Therefore, alleging medical negligence for giving wrong cancer report, the complainant underwent unnecessary operation, suffered mental agony and financial…

14.       JAMES PHILIP(Deceased) THROUGH LRs v. DR. H. UNNI KRISHNAN & ANR  Date: 2 Nov, 2015

..(chest) mass. Hence, it clearly shows the negligent attitude of the OPs in their duty that made a wrong diagnosis. The counsel stated that neurosurgeon at CMC Hospital, Vellore removed a piece of gauze…Plasmacytoma and Non-Hodgkins Lymphoma (NHL). Therefore, there was no negligence in the diagnosis and treatment, given to the patient. Arguments: 4. On behalf of complainant: (a) The learned…region with well preserved cleavage plane. CT appearance is nonspecific suggest following differential diagnosis: Germ Cell tumor ? thymoma ? secondary deposit 7. The discharge…

15.       DR.S.P.MANDAL v. GOPAL DASS  Date: 30 Apr, 2013

… Being aggrieved because of the utter neglect and deficiency in conducting a surgery based on the wrong diagnosis which led to amputation of his leg below the knee and 80% disability, Complainant…the treatment and surgery so much so that even in the discharge certificate it was stated in the column diagnosis that the Complainant was operated on the foot whereas in fact the surgery was performed…written submissions stated that the Complainant was admitted in Ram Lal Kundan Lal Orthopedics Hospital with a diagnosis of PPRP and he was operated on 06.07.1998 by a team of highly qualified…

16.       M/S. INDRAPRASTHA MEDICAL CORPORATION LTD. v. SMT. MOORTI SHARMA AND ORS  Date: 8 Dec, 2016

…Doctors and the specialist doctors were not available at crucial time. There was also wrong diagnosis/treatment given by the Doctors. The consumer complaint was then filed by Smt. Moorti Sharma, wife…11 th post-operative day. All necessary tests, investigations, diagnosis were conducted and the requisite and proper treatment was given, after acute relapsing pancreatitis was detected immediately…mg/dl, serum creatinin 2.0 and the total WBC count as 43800/cmm, which confirmed diagnosis of acute pancreatitis with renal failure. The medical record produced on file brings out that the Doctors at…

17.       Madhab Chand Mitter v. Apollo gleneagles Hospital Ltd. and 3 others District Consumer Disputes Redressal Commission, Date: 13 Oct, 2017

…o.p. 1 ? Whether the doctors who treated the patient committed any medical negligence? Whether there was any wrong treatment rendered by the doctors treated the patient? Whether there was any…standards of a reasonably competent practitioner in his field. V. In the realm of diagnosis and treatment there is scope for genuine difference of opinion and one professional doctor is…(2005) 6 SCC 1, it was observed by Hon’ble Supreme Court as : “When a patient dies or suffers some mishap, there is a tendency to blame the doctor for this. Things have gone …

Few more examples that have come to the notice are

1.         Max Hospital in Delhi surfaced gruesomely pointing out one of the mini loop holes in the existing healthcare system.  A 22 week old premature baby was declared dead at the hospital even though he was alive and handed over to his parents in a plastic bag along with his still born twin, when the parents found that the boy is alive was taken to a different hospital for care survive for week (misdiagnosis)

2.         A malpractice case against the forties hospital, gurgaon, 7 year old Arja Singh who suffered from Dengue allegedly lost her life due to negligence on the hospital part.  A major controversy erupted after the girls family they were charged INR 1.6 Milliion for treatment.  A subsequent government prob indicted the hospital for grave negligence lapse, unethical and unlawful act and found it minted as high as 108% profit margin in medicines and as High as 1737% margin in consumables.

3.         A four year old’s left testical removed after South Calorina Hospital due to diagnostic error as the boy was diagnosed with constipation in the first visit as the pain did not subside a second visit tot eh hospital the Doctor found that the spearmatic cord which providers blood flow to the testicals, rotates and become twisted the twisting cuts off the testicals blood supply and causes sudden pain and swelling.  To save the other testical the boy’s left testical was removed as the boy was correctly diagnosed in the first visit itself the testical would have been saved. 

Conclusion 

An article posted by Shalini Das Gupta, on January 3rd 2018 in Social Vibes, Kolkatta titled “The story of uncontrolled greed over life and death” (Raising a dialogue on private healthcare in India).  She has analysed and brought to notice many of the loop holes and remedial measures in improving the mistakes of diagnostic errors in healthcare industry. 

Quoting an am admi (common man) “healthcare because of the overall dependency of the system on capitalism, is being provided as a “product” instead of a “right” and therein lies in the issue, which is the basic difference between something being for “profit”  vs something being for “nonprofit”. “

In addition to this, many cases of increased dependency on medicines was observed which are being promoted by private practitioners to gain profits from Pharmaceutical Companies for patternizing.

However, no human being is 100% perfect and even the renowned specialist could make a mistake in diagnosing the true nature of the disease or ailment.  A healthcare professional can be held liable to negligence only if the patient can prove that the Doctor is guilty of failure that no other Doctor with ordinary skill would be guilty of if acting with reasonable care.  Sec. 304 A of the Indian Penal Code, 1860 makes it clear that “whoever causes death of a person by rash or negligent act not amounting to culpable homicide shall be punished with imprisonment for a term of two years or with a fine or with both”.  Sec. 80 and 88 of the I.P.C., gives a remedial defence for the doctors accused of criminal liability.  Under Sec. 80 (accident in doing a lawful act), under Sec. 80 nothing is an offence i.e., done by accident or misfortune or without any criminal intention or knowledge in the doing of a lawful act in a lawful manner by lawful means and with proper care and caution.  According to Sec. 88 a person cannot be accused for an offence if they performs an act in good faith for the others benefit, does not intend to cause harm even if there is a risk, and the patient as explicitly or implicitly given consent. 

Every year according to a survey about or around 5.2 million people dies due to human errors in India. Even in U.S., the figure is not less than 44,000 to 98,000. Basically it is not the skill or the knowledge but the theme of coordination and communication during an emergency that travels to medical errors.   

According to Dr. Shetti the pioneer of child cardiology lack of coordination and communication is the primary area where diagnostic errors will occur.  In the words of Srinath Reddy, President of the Public Health Foundation of India, an independent agency working on public health education and policy “Indians spend twice as much from their pockets as the Government does on health.  Almost 3/4ths of that spending goes on medicines”.  According to Jaya Datta Matron of Tapan Sinha Memorial Hospital for Railway Employees argues that “it is the lack of faith in the public healthcare system that the private healthcare sector utilizes.  Even though the quality of public healthcare in India has significantly include with enhanced infrastructure and technology a bias works that makes it difficult to lure patients.  The incidence of medical negligence in Government Healthcare Sector is due to shortage of manpower”.

To conclude the majority of the diagnostic errors can be prevented by improving the technology and making a coordination between healthcare professionals (Physicians, Surgeons, specialists) and technicians and Pathologists and by including the patients and the accomplice.  This coordination will help reduce diagnostic errors to the extent possible and can be minimized to the lowest ebb.

References:

  1. http://www.nationalacademies.org/hmd/Global/News%20Announcements/Crossing-the-Quality-Chasm-The-IOM-Health-Care-Quality-Initiative.aspx
  2. https://www.ncbi.nlm.nih.gov/books/NBK338594/
  3. https://www.amazon.com/How-Doctors-Think-Jerome-Groopman/dp/B0029LHWKY
  4. State Of Haryana & Ors v. Bala Devi – SC 25-01-2008
  5. Kusum Sharma And Others v. Batra Hospital And Medical Research Centre And Others SC – 10-02-2010
  6. VINOD JAIN v. SANTOKBA DURLABHJI MEMORIAL HOSPITAL SC – 25-02-2019(6)
  7. Dr. R. Jairam Iyer v. State Of Chhattisgarh HC – 08-07-2015 (7)
  8. M. LAKSHMINARASIMHAIAH & ORS. v. MEDICAL ADMINISTRATOR, BANGALORE HOSPITAL & ORS. NCDRC, Date: 29 Sep, 2008 (8)
  9. RAM CHANDRA RAI v. DR. MD. ZAHEER NCDRC, Date: 2 Sep, 2014(9)
  10. DR. R.K. PANDEY, SURGEON v. CHANDRA SHEKHAR PANDEY & 3 ORS NCDRC, Date: 10 Jul, 2014(10)
  11. SARAF HOSPITAL v. CHANDRA SHEKHAR PANDEY & 3 ORS.  NCDRC Date: 10 Jul, 2014 (11)
  12. POST GRADUATE INSTIT… v. MAMTA RANI @ BABLI &… NCDRC, Date: 24 Jan, 2017 (12)
  13. JASWINDER KUMAR, THR… v. POST GRADUATE INSTIT… NCDRC, Date: 24 Jan, 2017 (13)
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  18. DR.S.P.MANDAL v. GOPAL DASS  NCDRC, Date: 30 Apr, 2013 (18)
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  20. Madhab Chand Mitter v. Apollo gleneagles Hospital Ltd. and 3 others  District Consumer Disputes Redressal Commission, Date: 13 Oct, 2017 (20)

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