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Medical Board of California accuses gastroenterologist of gross negligence
eMediNexus,  21 February 2018
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  1. Dr. Dhaliwal is a gastroenterologist at Newport Beach, Calif.-based Hoag Hospital. 
  2. As per the board Dr. Dhaliwal repeatedly performed negligent acts, failed to maintain accurate records and violated the medical practice act when treating a 73-year-old, now deceased, man.
  3. Dr. Dhaliwal first saw the patient in April 2011. The man was taking three separate drugs to treat diabetes and coronary artery disease. 
  4. Dr. Dhaliwal had the man undergo laboratory studies, an upper endoscopy, a colonoscopy and an abdomen scan.
  5. A lesion was apparent in the upper part of the mans liver. 
  6. Additional testing was recommended. The lesion wasnt found in a follow-up ultrasound, so an MRI was recommended to get a closer look. Dr. Dhaliwal allegedly did not order any additional imaging, nor did he follow up on the lesion or any abnormal liver radiographic findings.
  7. Dr. Dhaliwal did conduct an upper endoscopy a few days later, but allegedly misidentified the patient as a 73-year-old female in his notes.
  8. A pathology report noted the patient had either an infection or stomach ulcers. The pathology report asked Dr. Dhaliwal to advise the patient to schedule a follow-up. Allegedly, Dr. Dhaliwal did not schedule a follow-up, nor did he adjust any of the mans medications, despite a risk of peptic ulcer disease-related bleeding or other complications.
  9. The man was admitted to the hospital by another physician in October 2011. The lesion on his liver was allegedly "significantly larger." The new physician scheduled imaging treatment, unaware that imaging had recently been done.
  10. The patient returned to Dr. Dhaliwal in late October 2011. Dr. Dhaliwal allegedly noted the liver lesion, but neither evaluated it nor attempted to treat it. Between October 2011 and August 2012, Dr. Dhaliwal allegedly made no mention of the liver lesion in any of his notes.
  11. The patient was hospitalized due to liver pain in August 2012. Dr. Dhaliwal consulted on the case. He attributed the pain to bloating, while noting an imaging scan found a mass on the patients liver. Allegedly, his physicians note ended with, "Overall the patient has a poor prognosis."
  12. The patient died October 2012 of liver cancer. Physicians said the mass was too large to properly remove.
  13. The board submitted the allegations and is considering future disciplinary action against Dr. Dhaliwal, including revoking his medical license. [Beckers GI & Endoscopy]

Lessons and comments: Dr KK Aggarwal

  1. Even clerical errors can be put against you (mistakenly writing F and not M)
  2. Always respond to comments written by Radiologist or Pathologist. If you do not follow their advise reason it out in your file.
  3. Always explain every finding to the patient even if you want to ignore it?
  4. Always ask the patient about previous investigations
  5. You are often prosecuted for not investigating a case. 

Comments

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  • Dr Dilip Pandit 27 February - 06:56 hrs

    Usg guided FNAC Was in order in October 2011, also proper documentation would have helped the doctor.

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  • Dr AKASH BHUYAN 23 February - 20:47 hrs

    Unfortunate incident. Should have followed up with an USG guided FNAC of liver mass.

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  • Dr Dr Brijmohan Rai Khadria 22 February - 19:29 hrs

    Ccommuncate all facts and findings to patient and not to ignore the findings of investigations.

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  • Dr arvind a desai 22 February - 07:56 hrs

    Communicate ,take consent in writing & get the patient & relatives to acknowledge your communication.

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  • Dr Nawal Kishore Pareek 22 February - 06:44 hrs

    its a gross negligence to ignore a imaging finding and identification ( M/ F) of client/patient.

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  • Dr Biranchinarayan Mallik 21 February - 23:42 hrs

    Use guided fanc of liver lesion ,MRI Scan of Liver are MUST for this elderly patient to exclude HCC or Mets in liver.

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  • Dr Ramesh Ganesan 21 February - 21:43 hrs

    As IMA said earlier , Decriminalization of medical profession must be done

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  • Dr Hasnain Patel 21 February - 18:57 hrs

    Sage advice

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  • Dr ANJANA PAYENG 21 February - 18:20 hrs

    Thanks for info.

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  • Dr gangadhara rao potluri 21 February - 18:15 hrs

    Unless we stick to the standards of basic clinical evaluation and proper recording we sometime are bound to land in trouble and pay the price.It is true that we dont put in a finger we will be putting our foot in and be in a unretreivable situation.

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