1. THIS complaint is filed by Smt. Santosh Gupta seeking compensation for medical negligence committed by the opposite parties due to which her husband Shri Mahesh Chand Gupta died. The complainant Nos. 2 to 4 are his children.
2. IT is the say of the complainant that late Shri Mahesh Chand Gupta was working as lecturer in Hublal Inter College, Agra, U.P. and was drawing a salary of Rs. 9,000 p.m. The opposite party No. 1 is Dr. G.G. Dhir, Skin Specialist, who was consulted during the period 27.7.1995 to 5.1.1996; opposite party No. 2 is Dr. R.B. Singhal, who was consulted on 8.1.1996; opposite party No. 3 is Dr. Smt. Janaki Kumari, who was consulted on 8.1.1996 and 9.1.1996; opposite party No. 4 is Dr. B.B. Maheshwari, who was consulted on 20.1.1996, and, opposite party No. 5 is Dr. S.K. Sama of Chiranjiv Clinic and Sama Nursing Home, New Delhi, where the patient was admitted during 23.1.1996 to 26.1.1996. In the complaint it is prayed that compensation for a sum of Rs. 10 lakh for mental agony, caused due to death of Shri Gupta, Rs.10 lakh for loss of income, Rs. 2 lakh for expenses in treatment and Rs. 10,000 for the cost of complaint totalling to Rs. 22,10,000 be awarded. Case of the Complainants :
The deceased, Mr. Mahesh Chand Gupta, visited opposite party No. 1 on 27.7.1995 as he noticed some boils on his legs. He was advised to take the prescribed medicine for 20 days by opposite party No. 1, Dr. G.G. Dhir, for which consultation fee of Rs. 70 was charged. He was advised to get urine and blood tested. The test results were shown to the opposite party No. 1 on 4.8.1995, when the deceased was advised to continue the medication which was prescribed earlier, and asked him to come regularly for consultation. The deceased visited opposite party No. 1 on 19.8.1995 and stated that he was not getting any relief. Opposite party No. 1 asked to continue the medicine regularly and gave another prescription. After taking these medicines for 25 days and not getting any relief, the deceased met opposite party No. 1 on 13.9.1995 and informed him about it. Hence, the O.P. No. 1 prescribed new medicines. Thereafter, on 17.12.1995 the deceased approached O.P. No. 1 and complained of not getting any relief. Then the O. P. No. 1 prescribed the Tablet "Depsonil". It is the say of the complainants that without doing any pathological test, opposite party No. 1 prescribed tablet "Depsonil" (Annexure - V) which is used in case of leprosy.
Thereafter, the son of the deceased, complainant No. 3 accompanied his father along with his mother to the clinic of opposite party No. 1 on 3.1.1996. It is alleged that when the complainants asked the doctor as to what was the actual ailment the patient was suffering from, the doctor (O.P. No. 1) became angry and no explanation was given except a direction to continue the medication for 15 days. The consumption of new medicines resulted into red spots on the back of the patient (deceased) in the evening on 4.1.1996. By 5.1.1996 there was swelling on the face of the patient and the face, the leg, the hand and the back of the patient became red and he had high temperature. The complainant Nos. 1 and 3 took the patient to the opposite party No. 1 and he gave medicines for malaria without getting any pathological report. When the complainants asked him to explain the disease he was very rude to them and asked the patient to continue the medicines.
3. THE complainant took the patient to Dr. Anil Kumar Agarwal, a Pathologist to check for malaria and the said report as per Annexure- , III states that malarial parasite was not seen.
By 8.1.1996 the whole body of the patient was swollen and he had high temperature and was vomiting. Complainant No. 1 called her relative Shri Pramod Gupta on phone and on his advice, complainant No. 1 consulted Dr. R.B. Singhal, opposite party No. 2 at his residence. Dr. Singhal advised blood test (Annexure -XB) and on seeing the report to be in normal range he told the complainant No .1 that it is a reaction of some medicine and he advised to contact Dr. Dhir again. It is the complainant''s case that Dr. Singhal should have given proper treatment to the patient even if he felt that it was a reaction to some medicine but he did not want to acknowledge the negligence of opposite party No. 1 and hence sent them to consult opposite party No. 1.
4. AFTER discussing with Dr. D.P.S. Kothari, through a contact of the complainants, who resides at Dholpur and he came to Agra on 8.1.1996 in the evening and on his advice Dr. Smt. Janak Kumari, a skin specialist in Agra, opposite party No. 3, was consulted. On 9.1.1996 again, the patient was taken to opposite party No. 3, Dr. Smt. Janak Kumari, after taking a consultation fee of Rs. 100 she issued another prescription letter and also advised the patient to continue the medicine for 15 days.
The complainants contended that Dr. Janak Kumari expressed her view that it seems to be the reaction of tablet "Odirox". It is stated that the tablet "Odirox-300" 300 mg (O.D) is a macrolides antibiotic tablet which should be prescribed after proper check up and after conducting enzyme test which is responsible for metabolism of the drug in the various parts of the body mainly in liver (G.T.P). It is averred that this tablet cannot be prescribed to such patients who are under treatment for a long time. It can only be prescribed after looking into physical position, age factor, body weight, time of administration, physiological factor, psychological factor and tolerance of body and after knowing the actual condition of the liver. "Odirox-300" 300 mg (O.D.) was prescribed on 3.1.1996 by opposite party No. 1 which being high dosage resulted in side effects and further became fatal to the patient.
The complainant''s case is that the patient ought not to have been given Odirox-300 for a long time and due to that, the patient suffered drug reaction and hence it is the negligence not only on the part of opposite party No. 1 but also opposite party No. 2 and opposite party No. 3 who recommended continuation of the same treatment.
5. SINCE there was no satisfactory development, the patient was shown to Dr. B.B. Maheswari, Lecturer, S.N. Medical College, Agra, opposite party No. 4, who charged consultation fee of Rs. 70 and advised blood test and in the said blood test, it was found that patient''s "Australian Antigen" was negative. According to the complainant this result showed that the patient was suffering from drug induced toxic hepatitis due to the reaction of the medicine prescribed by opposite party Nos. 1, 2 and 3. Pathology test report dated 21.1.1996 (Annexures XII and XIII) showed that S.G.P.T. level of the patient raised upto 1541 u/1, serum-bilirubin 11.1 mg which clearly indicated serious condition of the patient.
6. THE patient was admitted on 21.1.1996 in S.N. Medical College Hospital on the advice of Dr. B.B. Maheshwari. THE patient felt giddiness and started vomiting blood and later on became unconscious and opposite party No. 4, Dr. B.B. Maheshwari refused to come in the night but asked the complainants to take the patient to Delhi. Complainants contended that this behaviour of Dr. B.B. Maheshwari was nothing but negligence as he was irresponsible in attending to a serious patient.
The patient was carried to Delhi by private ambulance and admitted in a private Nursing Home of Dr. Sama, New Delhi. Dr. Sama and his colleagues after examining the patient declared the condition of the patient to be serious although they did not tell the reasons behind it. On 26.1.1996 at 4.05 a.m., the patient expired in Chiranjiv Clinic and Sama Nursing Home. It is contended by the complainants that Dr. Sama did not explain the cause of death and that it amounts to deficiency in service. Reply of O.P. No. 1
As against this opposite party No. 1 narrated the treatment given to the deceased (Mr. Gupta) in the following manner :
7. WHEN he examined Mr. Gupta first time on 1.8.1995, the patient presented himself with multiple itchy vialacious papula nodular lesions on the body which were symptoms of lichen-planus. He prescribed antibiotics, anti-allergic medicine - Dapsone and skin cream and asked for urine and blood tests to be done. On 3.8.1995, after noticing that blood and urine counts were in normal limits, he advised the patient to continue with the medication. On the next visit of the patient on 19.8.1995, when he found the response to the medicines was not very good, he put him on steroid medicines alongwith supporting antacid and incidal for stopping the itching. He further advised him to take Dicaris to potentiate the immunity of the patient to give immediate relief and Dityde to counteract side effects of steroid as it is diuretic, to take care of sodium and water retention. On the next visit on 13.9.1995, the response of the patient was good and he reduced the dose of steroid and advised to continue the rest of medication for next 20 days.
It is contended by the opposite party No. 1 that the patient did not visit him for the next 2 months till 17.12.1995 and he noticed that although there was mild recurrence of the disease for which he prescribed tablet Cortil (steroid) one tablet daily and to support this tablet, Dapsone (50 mg) TID was also prescribed.
8. THE patient came on 3.1.1996 with mild fever and mild fungal infection for which antibiotic, antacid and anti-allergic medicines, ointment for fungal infection were prescribed. He was advised to undergo blood tests for malaria positive. THE blood report showed that he was suffering from malaria and hence, Metakalfin tablet, Megaquin and Flexon tablet were prescribed. THE patient was having unbearable itching and Phenargan injection was prescribed. He advised the patient to consult his Physician immediately for malarial fever which was on 5.1.1996 and the patient never visited him after that nor had he informed about his illness.
Further, it is contended by opposite party No. 1 that the patient consulted many doctors after 5.1.1996 including Dr. R.B. Singhal, Dr. Janak Kumari, Dr. B.B. Maheshwari and finally Dr. S.K. Sama. Neither Dr. R.B. Singhal nor Dr. Janak Kumari have diagnosed him for jaundice or any other systematic symptoms. The patient expired on 26.1.1996 at Chiranjiv and Sama Nursing Home at New Delhi and the cause of death was shown as "Viral Hepatitis with Hepatic Encephalopathy." It is averred that there is no nexus which is attributable to the demise of the patient to the treatment administered by him. Thus, cause of death of the patient could be attributed if at all after the treatment by various other doctors as it is not even remotely related to the treatment given by him.
It is submitted by the learned Counsel for the opposite party No. 1 that there has been no negligence nor any deficiency or shortcoming in the treatment given to the patient. The treatment and medication that was prescribed was acceptable treatment as per standard and conventional method in the area of dermatology all over the world.
9. OPPOSITE party No. 1 also relied on the medical literature with evidence by way of affidavit wherein the medical proposition as prescribed by the text/reference books are given as under :
(i) In Park''s Textbook of Preventive and Social Medicine by K. Park 18th Edition, 2005 published by M/s. Banarsidas Bhanot Publishers : "India is a high risk area for malaria and is under threat of drug resistance to malarial drugs. (Page 201) A positive test is, therefore, not necessarily an indication of current infection and as such there are chances of failure of the test for malaria parasite. (Page 207) The health guides and multipurpose workers in India are fully trained to detect and treat cases of malaria at the community level with support for the referral level. It is further stated that in high risk area (such as India) the presumptive treatment of all suspected/clinical malaria cases involves simultaneous administration of tablets Chloroquine, Primaquine and in chloroquine resistance areas single dose of tablet Sulfalene/Sulfadoxine/Pyrimethamine can be given as presumptive treatment. Under toxic hazards of the malarial drugs it does not mention that the side effects of the drugs can cause the disease hepatitis. (Page 208)
(ii) In "Health Policies and Programmes in India" by Dr. D.K. Taneja, Doctors Publications in Chapter-7 titled "National Leprosy Eradication Programme" Page 74, it is stated that the drug Dapsone can be given in unsupervised doses.
(iii) In the article titled "Efficacy of Dapsone in Lichen Planus" by Bhushan Kumar, Indrajeet Kaur and V.K. Sharma in the Indian Journal of Venerol, Dermatol, Leprol, 1989 Vol. 55 Page 164 - "Dapsone a relatively non-toxic drug has been found to be effective in erosive lichen planus and was later reported to be curative in a similar situation." The patient was suffering from lichen planus and was advised Dapsone by opposite party No. 1.
(iv) In the article titled "Dapsone versus Carticosteroids in Lichen Planus" By Adarsh Chopra, R.R. Mittal, Bhupinder Kaur in the Indian Journal of Venerol, Dermatol, Leprol - It is given that "Dapsone has a therapeutic effect in lichen planus."
(v) In "Diseases of the Liver ad Billary System" by Sheila Sherlok and James Dooley 11th Edition published by Blackwell Science in Chapter 8 titled "Acute Liver Failure" at page 111-112 : "Most common cause of acute liver failure is viral hepatitis." In the same article the classification and causes of acute liver failure are given. However, though the patient in the present case died due to viral hepatitis which can be caused only by blood transfusion or through mother to baby in womb or by sexual intercourse with infected person. However, even normal hepatitis cannot be caused by any medicines prescribed by the opposite party No. 1 to the patient.
(vi) In "Harrison''s Principles of Internal Medicines" by Eugene Branwald, Stephen L. Hauser, Anthony S. Fauci, Dan L. Longo, Dennis L. Kasper, J. Larry Jameson (Eds) 15th Edition published by McGraw Hill, Medical Publishing Division in Section 2 titled "Liver and Bilary Tract Disease" under the sub title "Toxic and Drug Induced Hepatitis" by Jules L. Dienstag/Kurt J. Isselbacher at page 1739 : The table gives the various drugs which can cause Hepatitis. However, the same does not contain name of any drug prescribed by the opposite party No. 1. It is given that "Symptoms and laboratory findings usually subside within a few days of drug withdrawal and evidence of chronic liver disease has not been found on follow up." This demolishes the case of the complainant that the death of the patient was due to prescription of tablet Odirox O.D. 300 mg which admittedly was not taken for more than three days.
(vii) In "Robbins Pathologic basis of by Ramzi. Cotran, Vinay Kumar, Tucker Collins (Eds.) 6th Edition published by Harcourt India Private Limited in Chapter 17 titled "The liver and the Bilary Tract" under the Sub title "Viral Hepatitis" at page 856 it is given that "unless otherwise specified, the term ''Viral hepatitis'' is reserved for infection of the liver caused by a group of viruses having a peculiar affinity for liver.
10. LEARNED Counsel submitted that the opposite party No. 1 advised the patient to consult his Physician immediately for his malaria and also advised that if itching and, red spots occur, he was advised to take Phenargan injection after 4 to 6 hours. After this the patient/deceased never came back and the opposite party No. 1 cannot be held responsible for the subsequent treatment taken by the patient from other doctors. It is submitted that due care, caution and diligence were exercised in the treatment given to the patient/deceased and hence, the complaint should be dismissed with costs. Reply of O.P. No. 3
The opposite party No. 3, Dr. Janak Kumari submitted that she is a Specialist in skin diseases and possesses highest qualification both in India and England and that she worked in England for 16 years and accredited skin specialist of Royal College of Physicians, London. She submitted that when she examined the patient on 1.8.1996 for the first time, she found that the patient was suffering from severe skin condition known as "Exfoliative Dermatitis", a condition caused by various causes, important being unusual drug reaction.
In her reply, she opined that the said skin condition could be due to abnormal reaction to one of the drugs the patient was having earlier. She further submitted that the patient was advised to continue the treatment and report back next day but the patient never came back thereafter. Learned Counsel for the opposite party No. 3 further submitted that the patient did not die due to treatment given by her and the complaint against her should be dismissed with costs.
11. DR. R.B. Singhal and DR. B.B. Maheshwari, opposite party Nos. 2 and 4 respectively have not appeared. Reply of O.P. No. 5
For opposite party No. 5, Dr. S.K. Sama, who has been working in Ganga Ram Hospital since 1974 as Head of the Gastroenterology Department and Liver Diseases and presently the Chairman of the same hospital submitted that the patient was being treated at Agra outside Delhi for almost the entire period and that he was admitted in Sama Nursing Home only on 23.1.1996 and admittedly in a very serious condition. The patient was examined by himself and his colleagues Dr. G.H. Buxi and resident doctors - Dr. Suchitra Sengupta, Dr. Anjali and Dr. Moshmi Rai. After examining him in detail the accompanying relatives were explained regarding the condition of the patient at all stages. The cause of death was Viral Hepatitis with Hepatic Encephalopathy which substantiated with the record of the Nursing Home on which the initials of the receiving officer was also taken (Annexure R 5/III). Copies of these reports from their laboratory were also annexed in hospital record and the same had been given to the relatives.
12. IT is further averred that the complainants despite having the knowledge as to cause of death still allege that they were not informed of the same.
It is further stated that the team of doctors in their hospital tried to mitigate the severity of the disease during the three days'' period when the patient was with them. Considering that the patient suffered from Viral Hepatitis with Hepatic Encephalopathy and was admitted at the last stage in a very serious condition, it could not be said that he died of any negligence from the treatment given by them. Findings :
We heard both the parties and perused the records carefully and the replies to the interrogatories filed on behalf of the parties.
13. REGARDING Dr. R.B. Singhal, Dr. Smt. Janak Kumari, Dr. B.B. Maheshwari and Dr. Sama, we find complainants'' allegations have no substance. Dr. Singhal did not appear during the proceedings. As per the complainants'' contention regarding Dr. Singhal that after examining the patient he advised pathological test of blood and on seeing the report to be in normal range, the doctor opined that it is a reaction of some medicine and advised the patient to contact opposite party No. 1, Dr. G.G. Dhir again. As for the allegation that Dr. Singhal was helping his colleague (Dr. G.G. Dhir) and did not clearly disclose to the complainant that Dr. Dhir was negligent in the treatment, there is nothing on record to prove the same. Hence, there is no substance in this allegation.
14. DR. Janak Kumari, opposite party No. 3 in her affidavit clearly stated that complainants'' case is of drug reaction and the death is not caused due to drugs prescribed by her for the skin ailment.
Dr. B.B. Maheshwari did not appear during the proceedings but his role is very limited. Complainants'' contention was that he made a telephone call at his residence in night when the patient was vomiting and requested him to visit the patient which he refused. There is no evidence to support this bald statement made by the complainants.
Dr. S.K. Sama, opposite party No. 5 submits that the cause of death was Viral Hepatitis with Hepatic Encephalopathy and the patient was admittedly brought in a very serious condition and despite their best treatment the patient died in their hospital which cannot be considered negligence by medical standards.
15. LASTLY, we would consider the allegations made by the complainants against opposite party No. 1, Dr. Dhir. The three main allegations of negligence against opposite party No. 1 are :
(a) The drug Dapsone should not have been prescribed; (b) That while the correct dosage of tablet Odirox should be 150 mg in P.D (twice in a day) the opposite party No. 1 prescribed Odirox 300 mg (one daily) which is over dose which resulted in side effects and proved dangerous to the life of the patient and hence it amounts to negligence; and (c) The opposite party No. 1 prescribed certain malarial drugs on 5.1.1996 without any pathological tests. It is alleged that the complainant No. 3 on his own got a pathological test done on 7.1.1996 which proved negative for malaria. It is, therefore, argued that prescribing malarial drug on 5th was a wrong step and hence amounts to deficiency of service and negligence.
We find there is no merit in any of the three allegations for the following reasons :
(a) The patient was diagnosed having skin disease Lichen Planus. Two medical journals, which have been brought on record, have articles showing that Dapsone is a drug of choice for the above disease. Medical literature also shows that Dapsone is a relatively non-toxic drug and hence we find that there is no deficiency in service or medical negligence on this allegation.
(b) The patient died of Viral Hepatitis. Medical literature brought on record shows that various drugs can cause drug induced Hepatitis. However, Odirox is not shown in the list of such drugs and no evidence has been led to show that Odirox 300 mg has caused Hepatitis. Odirox is a broad spectrum antibiotic which is used in the skin and soft tissue disease and does not cause liver damage. It has got no drug reaction and it consists of Roxythromycin. Patient can be safely advised Roxythromycin/Odirox for 7 days on the basis of clinical assessment of the patient by the doctor. It is also admitted that Odirox was taken for three days from 3.1.1996 to 5.1.1996. Considering the medical literature which is supporting the treatment given i.e. prescribing Odirox for the patient, we do not find any substance in the allegations made by the complainants in this regard.
(c) The extracts filed by Park''s Textbook on Preventive and Social Medicine show that India is a high risk area for malaria and also indicates that a negative pathological test result for malaria parasite is no proof that the patient does not have malaria. It is further mentioned that preventive treatment of all suspected/clinical malaria cases involves simultaneous administration of tablet Chloroquine and tablet Primaquine. Medical literature also does not indicate under the head "Toxic hazards on malarial drugs" that such drugs can cause hepatitis. In India, it is accepted practice to treat for malaria based on suspected clinical diagnosis, we find the treatment given by opposite party No. 1 in this regard is justified and does not amount to medical negligence.
16. THE patient continued in his treatment for dermatological problems and that has no bearing on the death of the patient. Patient responded to the treatment for the dermatological problem faced by him. THE post-mortem report clearly indicated cause of death to be ''Viral Hepatitis with Hepatic Encephalopathy'' and the treatment given by doctors has no relevance to the death of the patient.
In view of our above findings namely :
(a) "Dapsone" tablets are the preferred treatment for the Lichen Planus - the skin disease, the deceased was suffering from and medical literature shows that Dapsone is a relatively non-toxic drug;
(b) that no evidence has been led to show-that the medicine "Odirox" causes Hepatitis nor any evidence to show that an over dose of Odirox was administered and O.P. No. 3, Dr. Janak Kumari, opined that the Exfoliative Dermatitis could be due to abnormal drug reaction from one of the drugs which he was using earlier and she also stated that it cannot definitely be attributed to tablet Odirox;
(c) That the negative pathological test for malarial parasite is no proof that the patient does not have malaria;
(d) That the preventive treatment for all suspected malaria cases in India which is a high risk area for malaria is administration of tablets Chloroquine and Primaquine;
(e) That medical literature does not show that these drugs can cause Hepatitis; that the patient''s death from Hepatitis has no connection with the treatment given.
For the reasons stated above, in our view, there is no negligence or deficiency in service by the opposite parties. Hence, the complaint is dismissed. There shall be no order as to costs. Complaint dismissed.
