I am at present working in a Govt. Hospital where Biometry machine is out of order for a long time. Hence I am doing Cataract Surgery without doing Biometry Test and implanting Lens arbitrary(as available from stock of IOL ). Can any pt. raise a MEDICO-LEGAL issue against me ?
Dear Dr. Chatterjee,
Yes, it can be a medicolegal issue, because the standard of care expected in today's world is more than what you are doing Sir. In fact, before you think of legal issues, it is the attitude to try to excel in every case which helps you achieve greater heights. Keep on writing to the government to provide the equipment. Sometimes they listen! Till then send your patients to the nearest ophthalmologist in private sector for biometry. He can do it for a nominal charge.
Dr. Amandeep Singh
Dr. Chatterjee, The Doctor is solely responsible for all the eventualities of a surgery. All the factors that you have mentioned are not counted at all by law. Doing cataract surgery without a Biometry is not right. Please get the biometer repaired or replaced, immediately, or ask patients to get the test done in a nearby eye hospital.
Doing IOL implantation without biometry is definitely a deficit in service and can invite medico-legal problem. I too served in a Govt Medical College where such problem comes up from time to time. Fortunately there are 2-3 private optical shops where biometry is done for a small fee and the patients are advised to get it done there before the surgery is undertaken.
Dear Dr Chatterjee,
By definition, not doing something which in ordinary prudence should have been done, constitute a medical negligence.Therefore you get your answer.
Dr. P. Roy.
Dear Dr Bidyut Chatterjee,
Few Facts for you :
1. The Supreme Court has ruled that the Surgeon is the CAPTAIN OF THE SHIP and responsibility direct and vicarious finally rests on the shoulders of the operating surgeon . This includes errors by sister /OT staff / OPD Staff which have a direct bearing on the surgical result . We as operating surgeon are supposed to be overlooking and supervising the entire sequence of events/ rocedures which have a bearing on the surgical and visual outcome.
2. Pl refer to "Guidelines to the management of catraract in India' - developed by Vison 2020: The Right to Sight - India. This manual released in Nov 2011 has foreword by The Director General of
NPCB,Ministry of Health & Family Welfare , Govt of India who has officially endorsed it as the guideline to cataract surgery in India.Cataract surgery module number 4 of this manual deals with IOL power calculation and it explicitly mentions that either ultrasound Biometry / parital interference interferometry (IOL Master/Lenstar) should be used for IOL power calculation.. The Summary at the end of the module reads " Biometry and correct IOL power calculation is a critical factor for good visual outcome and a satisfied patient' In view of both the above , there always exists the possibility of the surgeon being sued /taken to court if a patient has marked sub optimal vision. Being in a government set up , you cannot be taken to consumer court but no one can stop the patient from initiating criminal proceedings on the grounds of negligence of accepted/official norms for cataract surgery. Remember the administration will wash their hands off as they will call it a medical procedure problem which falls in the surgeon's purview.
You have two options to get around your problem :
1. Get the biometry done elsewhere and use it .
2. Quote the Govt of India manual which I referred to in para 2 and write a letter to your administrative head explaining why you cannot do cataract surgery in your present set up Chances are your A scan machine will get repaired/ replaced soon !
Dr Vasanth Kumar Ramanathan
Apart from litigation, IOL implant without Biometry should not be done.
Dr Ashok Mehta
Thanks to all of you .I understand that doing IOLs without Biometry is very bad job which I was not able to impress my seniors administrators (non ophthalmologists).Now with your all hard evidence I hope to make them realize it.