76 lakh
compensation, in these types of cases the associations should become a party?
Dr
KK Aggarwal
President
CMAAO and HCFI
15 years later
in a case treated at Maharaja Agrasen Hospital in which a new-born resulted in
total blindness of a new-born; the Supreme Court has awarded compensation
of Rs 76 lakh to the family.
A bench of
Justices U. U. Lalit and Indu Malhotra held the hospital, its paediatrician and
ophthalmologist guilty of medical negligence as they failed to carry out the
mandatory retinopathy of prematurity (ROP) check on the pre-term baby, which
led to his total blindness. The court also slammed the hospital for not sharing
the medical records of the child, born in 2005, with his parents for over two
years after discharge to enable them to approach other doctors for treatment.
The baby was
brought to the hospital for medical examination from time to time for more than
three months, but the doctors did not undertake the test.
The bench
awarded a compensation of Rs 76 lakh out of which Rs 60 lakh was allocated for
the child’s education, welfare and sustenance. Rs 15 lakh was allocated to the
mother as his caregiver and Rs 1 lakh towards litigation cost.
The court
upheld the National Consumer Commission’s order that it was a case of medical negligence.
ROP
1. Retinopathy of
prematurity is a developmental vascular proliferative disorder that occurs in
the retina of preterm infants with incomplete retinal vascularization.
2. ROP is an important cause of severe visual impairment
in childhood.
3. Other ophthalmologic
disorders that occur frequently in preterm infants include amblyopia,
strabismus, and refractive errors.
4. Guidelines suggest screening all infants with birth
weight (BW) ≤1500 g or gestational age (GA) ≤30 weeks
5. One should also screen those with BW between 1500 g and 2000 g or GA
>30 weeks whose clinical course places them at increased risk for ROP (as
determined by the neonatologist).
6. Canadian Paediatric Society suggest screening for infants with birth
weight ≤1250 g and infants with GA <31 weeks regardless of BW
7. Do we have Asian guidelines?
8. Screening for ROP is a labour-intensive process with a relatively low
yield; <10 percent of infants who are screened require treatment
9. The optimal criteria for screening remain uncertain.
10.
Research has focused on developing prediction
models to identify high-risk infants with the hope of reducing the number of
infants requiring ophthalmologic examinations. However, these methods require
additional validation in broad populations before changes to the screening
recommendations can be made.
11.
The screening evaluation consists of a comprehensive
eye examination performed by an ophthalmologist with expertise in
neonatal disorders
12.
How many paediatric ophthalmologists
we have in the country?
13.
And how many neonatal ophthalmologists
we have in the country
14.
The pupil must be dilated in order to visualize the
vitreous and retina.
15.
The protocol is to use a combination eyedrop (Cyclomydril,
which contains weak concentrations of phenylephrine and cyclopentolate)
30 minutes or more before the examination. Both manipulation of the eye and
the cycloplegic eyedrops can produce adverse cardiorespiratory and
gastrointestinal effects (e.g., bradycardia, arrhythmia, apnoea, desaturation,
emesis). Therefore, it is essential to carefully monitor the infant
during and after the examination procedure. Topical anaesthetic can be used
based on the preference of the examining clinician
16.
How many centers in India
would have this facility?
17.
The retina is examined by looking through the pupil
with an indirect ophthalmoscope with a 20 or 28 diopter condensing lens while
the eyelids are retracted with a speculum. ROP is most commonly visualized in
the peripheral retina, which often is obscured by the iris. In order to
completely view this area, a scleral depressor is used to indent the eye
externally.
18.
Alternatively, telemedicine systems can be used to
identify infants with potentially severe ROP.
19.
How many centers are trained
for this?
20.
Start screening
examinations at 30 weeks postmenstrual age (PMA) for infants born at 22 to 26
weeks and at 4 weeks of chronologic age for infants born at ≥27 weeks. Treatable
ROP rarely occurs before 31 weeks PMA, most initiate screening at 30 weeks PMA
to account for the possibility of errors in dating, examination delays due to
medical status, and to permit flexibility in scheduling.
21.
Additional examinations are performed at intervals
of one to three weeks until the retinal vessels have completely grown out to
the ora serrata (periphery of the retina). If ROP develops, the eyes are
examined more frequently, depending upon the severity of disease and rate of
progression.
The Indian Retinopathy
of Prematurity (IROP) Society
Established in July 2016. The menace of retinopathy of
prematurity blindness had reached alarming proportions in the nation. The
number of pre-terms born had crossed 3.5 million annually.
Improved neonatal survival, over 700 special neonatal care
units (SNCUs), a very low prevalence of ROP screening programs and only a
handful of ROP specialists are some of the problems.
With over 20,000 ophthalmologist members of the All India
Ophthalmological Society, nearly 2000 are Vitreo-Retinal Society of India
members. So less than 1% of ophthalmologists in the country are involved
directly in ROP care.
Conclusions: India Ophthalmological Society should have been the party in
this case or 10% of all 3.5 million cases of premature delivers will file cases
in courts for compensations as 2000 vitreo- retinal specialist cannot take care
of this large number.
After ROP it can be a case of missing all congenital heart diseases in
the hospital, that amounts of 1% of all births.
Good
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