Medical negligence or diagnostic conundrum? A medico-legal case study

India is a signatory to the UN backed Consumer Protection Resolution, and has enacted the Consumer Protection Act in 1986 to promote and protect the rights of consumers. A land-mark judgment of the Supreme Court of India in 1996, has paved the way for a number of lawsuits involving the public sector, including an eminent tertiary care medical institution. The case described in this study was filed with the State Consumer Dispute Redressal Commission in June 2000. The complainant was a fifty year old female who noticed a lump in her right breast; which was diagnosed as malignant by fine needle aspiration cytology (FNAC); and was treated by surgery and adjuvantradio-therapy (brachytherapy). Subsequently, the tissue sent for histo-pathological study was reported to be 'benign phyllodes tumour'; which was confirmed by other centres in India and the UK. The complaint filed for total damages amounting to Rupees 19 lacs (approx. 27,300 UK pounds) along with interest from the date of operation. Review of the relevant literature suggests that phyllodes tumour of the breast has various sub-types;and even borderline cases can develop malignancy at a later date. It is also clear that false positive cases had been reported previously in cases diagnosed by FNAC. Finally, avenues to minimise litigation through in-house mechanisms and a new concept of mediation have been explored.