State Consumer Disputes Redressal Commission
S. Srinivasa S/O. Late S. Shama Rao vs Dr. Ramesh Jois, Md, Mrcp(Uk) on 30 September, 2022
Daily Order BEFORE THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BANGALORE DATED THIS THE 30TH DAY OF SEPTEMBER 2022 PRESENT SRI. RAVI SHANKAR : JUDICIAL MEMBER SMT. SUNITA C. BAGEWADI : MEMBER Appeal No. 710/2014 S. Srinivasa S/o. Late S. Shama Rao Aged about 65 years, R/at "Vanasuma", No. 442, 3rd Cross, 2nd Block, 1st Stage, Nagarabhavi, BDA Layout, Bangalore 560072 (By SRI. Imran Pasha) V/s ....Appellant Dr. Ramesh Jois, MD, MRCP(UK) CCST (Rheum) UK, Consultant Rheumatologist, R/at No. 98, 2nd Cross, Central Excise Layout, Vijayanagar, Bangalore 560040 and he is a consulting Doctor at Fortis Hospital, Bannerghatta Road, Opp. IIM, Bangalore 560076 and also Kanva Diagnostics, 2/10, Dr. Rajkumar Road, 4th N Block, Rajajinagar, Bangalore 560010 and also at Mallige Medical Centre, No. 31/32, Crescent Road, Bangalore 560001 (By Sri. Dr. S.V Joga Rao) .....Respondent O R D E R
BY SMT. SUNITA C. BAGEWADI, MEMBER The complainant preferred this appeal against the order dated 07.05.2014 passed in C.C.No.456/2013 on the file I Additional District Consumer Disputes Redressal Forum, Bangalore.
The brief facts of the case are that complainant's wife Smt.K.J.Pushpalatha had ulcer inner side of her left thigh from April 2012. Hence, she had consulted one Dr. Venktraman Mysore for treatment and inturn who has referred to Dr. Ramesh Jois, consulting doctor of OP No.1. The wound was diagnosed as Gangrenosium Pyoderma. Dr. Ramesh Jois started the treatment from 25.09.2012 and prescribed the medicine Augmentin-Duo, Anti-CCP anti 80 +ve body RBS 82 and withhold Azathioprine for 10 days. These medicines were not give improvement in curing the wound therefore, complainant along with his wife visited Dr.Ramesh Jois on 01.10.2012 at Kanva Hospital, Rajajinagar, Bangalore and advised to continue the medicines of Augementin-Duo 625, clean wound T Saline for 7 days. Since there is no improvement from the medicines again visited Dr. Ramesh Jois on 17.10.2012 and doctor prescribed new medicines of Omnacortile 20 mg, Folitrax 10 mg once weekly, FOL-5 Hab FRI night 3 moniter sugars regularly. When complainant's wife visited Dr. Ramesh Jois on 06.11.2012, there were noticeable changes in the behavior of the patient i.e., cursing, weeping etc., and also symptoms of depression had developed, complainant made enquiry with Dr. Ramesh Jois, but, doctor has not explained why she got all the above said changes but suppressed the true facts and advised to take Omnacortil 20 mg, Fol-5, Folitrax 10 mg, Anxit 0.5 mg and Omez 20 mg. On the advice of Dr. Ramesh Jois complainant admitted to the hospital on 15.11.2012. The Mallige Hospital doctors recorded the conditions of the patient, after completion of their genera checkup, one Dr.Ravindra T.S. diagnosed the following:
Type 2 Diabetes Mellitus, Hypertension, Rheumatoid Arthritis, Hypothyroidism, Pyoderma Gangrenosum, Bilateral Pneumonia with ARDS, Septic Shock, Acute Renal Failure The Complainant's wife was admitted to the ICU and treated at ICU at Mallige Hospital from 15.11.2012 and put on ventilator on 20.11.2012 and Dr. Ramesh Jois treated wife of complainant. Thereafter, Dr. Ramesh Jois did not come and treated the complainant's wife under that circumstances, complainant got discharged his wife from Mallige Hospital on 24.11.2012 and admitted to the Panacea Hospital, Nagarbhavi on 24.11.2012. Treatment was continued but complainant's wife expired on 26.11.2012 because of negligent treatment given by Dr. Ramesh Jois. The doctor had not taken into consideration while giving advice to Smt. K.J. Pushpalatha to take 50 mg per day and further Dr. Ramesh Jois has not checked the complete conditions of the patient before advice to take OMNACORTIL 20 mg to know her complete health condition. It was the duty of the responsible doctor before giving advice or prescribing to take dangerous medicine like OMNACORTIL 20 mg but doctor has not taken sufficient care as required before prescribing the medicine to the complainant. This is very clear that complainant's wife died due to failure of multi organ and her multi organ failure was due to the medicine of Omnacortil prescribed by Dr. Ramesh Jois and he has not given right treatment at right time as required and due to his medical negligence she lost her life. The complainant has spent about Rs.3,10,000/- on the treatment of his wife at Mallige Hospital on the advice of Dr. Ramesh Jois and Panecea Hospital. Complainant has lost his beloved wife at the age of 63 years, when he was in very much need and assistance of his wife as partner, advisor and care taker totally she is the life of the complainant. Hence, this complaint.
On issuance of notice, OPs appeared through their counsel and filed their version. In the version OPs contended that the complainant was referred by Dr. Venkatram Mysore on 25.09.2012 to the OP who is a consultant Rheumatologist and assessed the complainant's wife and found that she had developed a large ulcer over her left thigh, which initially started as a small boil and progressed over a few months from June 2012, it was very painful and she was barely able to walk. It was also found that she was diabetic but the sugar was under control as per the blood report FBS 98. The other blood tests that were conducted showed a normal blood count ( CBC) and liver function (SGPT). Complainant's wife also complained of intermittent joint pains for the last three years for which she was not on treatment. A blood test conducted for Rheumatoid arthritis called rheumatoid fact was strongly positive (176). A biopsy of the ulcer done by Dr. Venkatram Mysore was suggestive of a rare disease called "Pyoderma Gangrenosium". The complainant's wife was infact being treated by Dr.Venkatram Mysore who after having tried various ointments without major benefits had started the patient on Azoran 75 mg daily tablets. It is an immune suppressive drug. The patient therefore was already being treated by immune suppressive drugs by the time she was referred to the OP. The OP prescribed an appropriate antibiotic namely 'Augmentine Duo' and the immune suppressive drug 'Azaron' was withheld. In order to reconfirm the diagnosis of 'Rheumatoid Arthritis' another blood test called anti CCP, antibody was done and which also came back strongly positive. Therefore, after two courses of antibiotics for a total period of 17 days and after stopping the initial immune suppressive drug 'Azoran' it was observed that the infection had resolved but the original problem i.e., the painful ulcer of PG persisted. After ensuring there was no other problems it was decided to start the patient on steroids by prescribing 'OMNACORTIL' for the large non healing painful ulcer. The literature also suggests a dose of 1-2 mg per kg of body weight per day. Although the patient weighed 91 kg a lower dose of 50 mg per day was chosen, since the patient was diabetic. Further complainant and his wife were counseled about the possible side effects of steroids which is the normal practice. Before giving the prescription, instructions were given to monitor the sugar levels closely with the physician K.P. Balraj. Therefore, all the adequate precautions were taken before prescribing the steroid 'OMNACORTIL'. After administering 'OMNACORTIL' for 19 days on 06.11.2012 it was noted that the pain had significantly reduced and size of the wound which suggested an improvement in the PG and surrounding infection was resolved. Patient had mild psychosis which is sometimes seen in patients taking steroids. In view of the satisfactory improvement of PG the dose of OMNACORTIL was reduced from 40 mg to 30 mg and further to 20 mg after 10 days with the plan to see the patient again in 3 weeks. On arrival at MMC at 7 p.m. as documented in the case sheet it was noted that the patient was unwell for two days and had fever for one day. An urgent X-ray was taken at the OPD showed Pneumonia on both sides. Hence, the OP brought in Dr. T.S. Ravindra Senior Chief Physician and intensivist to see the patient. As per the assessment done by Dr.T.S.Ravindra, it was found she had Bilateral Pneumonia and Septicemia and in view of the poor health sources she was admitted to the ICU and MMC after obtaining permission from her husband. After being admitted under Dr. T.S. Ravindra the patient was discharged against medical advice as can be seen from the discharge summary produced by the complainant. Thereafter the patient having been discharged against medical advice breathed her last on 26.11.2012 at Panacea Hospital. The cause of death shown in the death certificate is Bilateral Pneumonia, Septicemia and multi organ failure. The OP in no way be held responsible for any medical negligence as alleged and is not liable to pay compensation and denies other allegation made in the complaint and prays for dismissal of the complaint.
After trial District Commission dismissed the complaint.
Aggrieved by the order the complainant has preferred this appeal.
Perused the appeal memo, order passed by District Commission and materials on record. We noticed that it is an admitted fact that wife of complainant Smt. K.J. Pushpalatha had ulcer inner side of her left thigh from April 2012. Hence, she had consulted one Dr. Venktraman Mysore for treatment and in turn who has referred to Dr. Ramesh Jois, consulting doctor of OP No.1. The wound was diagnosed as Gangrenosium Pyoderma. Dr.Ramesh Jois started the treatment from 25.09.2012 and prescribed the medicine Augmentin Duo, Anti-CCP anti 80+ve body RBS 82 and withhold Azathioprine for 10 days. It is also admitted fact that these medicines were not given improvement in curing the wound therefore complainant along with his wife visited Dr. Ramesh Jois on 01.10.2012 at Kanva Hospital, Rajajinagar, Bangalore again and Dr.Ramesh Jois advised to continue the medicines of Augementin-Duo 625, clean wound T Saline for 7 days. When there is no improvement from the medicines prescribed earlier again the patient visited Dr. Ramesh Jois on 17.10.2012 and doctor prescribed new drugs called Omancortile 20 mg, Folitrax 10 mg once weekly, FOL-5 Hab FRI nigh5 3 moniter sugars regularly. It is also admitted fact that on the advice of Dr. Ramesh Jois the complainant admitted his wife in the Mallige Hospital on 15.11.2012 and in the Mallige Hospital the doctors recorded the conditions of the patient, after completion of their general checkup as follows:
Type 2 Diabetes Mellius, Hypertension, Rheumatoid Arthritis, Hypothyroidism, Pyoderma Gangrenosum, Bilateral Pheumonia with ARDS, Septic Shock, Acute Renal Failure It is also admitted fact that wife of complainant was admitted to the ICU and treated at ICU at Mallige Hospital from 15.11.2012 and put on ventilator on 20.11.2012 and Dr. Ramesh Jois was treated the patient in the said hospital. Thereafter, Dr. Ramesh Jois did not come and treated the complainant's wife and patient got discharged from Mallige Hospital on 24.11.2012 and admitted to Panacea Hospital, Nagrabhavi on 24.11.2012. Treatment was continued, but, complainant's wife expired on 26.11.2012. The allegations of the appellant is that due to negligence treatment given by Dr.Ramesh Jois who had not taken into consideration while giving advice of taking Omnacortil 50 mg tablet per day, the wife of complainant expired on 26.11.2012. Moreover, doctor has not taken sufficient care before prescribing medicine and due to excess administration of steroid, the patient suffered other side effects and consequently passed away.
Perused the order passed by the District Commission and materials on record. We noticed that respondent has treated the patient according to the medical rules and experts in the field. Respondent has considered the condition and history of the patient. He has advised blood tests and referred the blood tests/slides to ADL for second opinion regarding PG (Pyoderma Gangrenosium) and thus he had prescribed Omnacortil tablet which was standard line of Rx for PG after considering the age of complainant's wife as per medical literature. The OP also advised another doctor for monitoring sugar regularly because patient was diabetic. When he noticed improvement in the patient's condition dosage of Omnacortil was tapered off. Subsequently, on 15.11.2012 when OP received call from the patient consider the symptoms of patient's which shows Peumonia, the patient immediately referred to Dr. T.S. Ravindra for treatment in Mallige Hospital because respondent was Rheumatologist not Intensivist. Unfortunately, the patient was discharged from the Mallige Hospital on 24.11.2012 against the medical advice and admitted in Panacea Hospital and passed away in Panacea Hospital on 26.11.2012.
Appellant has alleged that due to excess administration of steroids (Omnacortil tablet) the patient suffered multi organ failure and passed away. However, the appellant has not established that which was the suitable medicine for PG except Omnacortil and what was the line of treatment for PG other than the respondent doctor has followed. If such allegations were made by the appellant then burden lies on the appellant only to prove the allegation along with sufficient documents. The appellant has not produced any cogent evidence before the lower court to prove his allegation.
Omnacortil is steroid drug which is used for the treatment of PG and also in arthritis, asthma, allergy, certain types of cancer, skin, eye, thyroid or intestinal problems. It works by blocking the action of chemical substance that are responsible for pain and swelling it has some minor side effects such as headache, vomiting, upset stomach, anxiety, sleeplessness etc. Administration of Omnacortil does not cause multi organ failure. Moreover, perused the expert evidence. The expert body of KMC did not find prima-facie case of medical negligence. Even though cross-examination of President of Council Dr. Chikkananjappa was conducted in lower court and he clarified that "in this particular case as a last resort the doctor administered the steroid under the cover of antibiotics and immune suppressing drugs. The patient is treated according to the protocol as well as expertise n the field" and also in the death certificate the cause of death was shown Pneumonia with ARDS in Septicemia and multi organ failure. Moreover, the appellant's wife suffered from other diseases due to PG such as Type 2 Diabetes Mellitus, Hypertension, Rheumatoid Arthritis, Hypothyroidism, Bilateral Pneumonia with ARDS, Septic Shock, Acute Renal Failure which was recorded by one doctor of Mallige hospital after the general checkup. Hence, considering the facts and discussion made here and after perusing the materials on record we are of the opinion that appellant has failed to prove negligence against the respondent. Hence, the order passed by the District Commission is just and proper. No interference is required. Hence, appeal is dismissed. No order as to costs.
MEMBER JUDICIAL MEMBER CV*