State Consumer Disputes Redressal Commission
G. Mariyamma, vs Dr. P. Rajasekhar, Md (General) on 18 July, 2011
A A.P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION HYDERABAD. F.A. 259/2009 against C.C. 45/2008, Dist. Forum, Kurnool Between: G. Mariyamma, W/o. Late G. Devadas H.No. 51-1026, F1 LIC Colony, Kurnool. *** Appellant/ Complainant And Dr. P. Rajasekhar, MD (General) Asst. Professor of Medicine Govt. General Hospital Kurnool. *** Respondent/ O.P Counsel for the Appellant: M/s. G. Nagabhushanam Counsel for the Resp: M/s. U. Ramanjaneyulu F.A. 508/2010 against C.C. 45/2008, Dist. Forum, Kurnool Between: Dr. P. Rajasekhar, MD (General) Asst. Professor of Medicine Govt. General Hospital Kurnool. *** Appellant/ O.P And G. Mariyamma, W/o. Late G. Devadas H.No. 51-1026, F1 LIC Colony, Kurnool. *** Respondent/ Complainant Counsel for the Appellant: M/s. U. Ramanjaneyulu Counsel for the Resp: M/s. G. Nagabhushanam CORAM: HONBLE SRI JUSTICE D. APPA RAO, PRESIDENT SMT. M. SHREESHA, MEMBER
& SRI R. L. NARASIMHA RAO, MEMBER MONDAY, THIS THE EIGHTEENTH DAY OF JULY TWO THOUSAND ELEVEN Oral Order: (Per Honble Justice D. Appa Rao, President) ***
1) These cross-appeals viz., F.A. 259/2009 preferred by the complainant against inadequacy of compensation awarded, while the respondent doctor filed F.A. 508/2010 against very awarding of compensation.
2) Since both these appeals arise out of the same order the parties are described as arrayed in the complaint for felicity of expression, and to avoid confusion.
3) The case of the complainant in brief is that she is 70 years old senior citizen having good health. While so, on 1.2.2006 at about 9.30 p.m. when she got some burning sensation in her stomach due to acidity she went to opposite party clinic for treatment. He took her B.P which showed 180/100 mm Hg. It might be due to her anxiety due to burning sensation. After conducting tests however without asserting her age he had conducted tests like ECH, Echo, TMT etc. and administered directly heavy doses of Prozopress XL 2.5 mg along with Cyra 20 mg for acidity. In fact the medical authorities mention that it should always to be started at low dose of 0.5 mg at bed time and gradually increase twice till adequate response is produced. If heavy dose is administered straightaway adverse effects of prozosin would be hypertension related symptoms like headache, drowsiness, dry mouth, weakness, palpitation, nasal blockage, blurred vision etc. At any rate it should not be used as first choice drug. On 1.2.2006 she took one tablet Prozopress XL 2.5 mg along with Cyra 20 mg in the night. On the next day morning at 7.30 a.m. she fell down unconsciously due to low blood pressure. Observing her symptoms she was shifted to Gowri Gopal Hospital at about 8.00 a.m. for treatment. After taking B.P the doctor informed that she was suffering from low B.P and adequate treatment was given after nearly collecting Rs. 5,000/- towards medical and other expenses. When her son approached the opposite party doctor and informed about the complications, he promised to bear the expenses, however he did not pay any amount. Again after going to the house she fell down and had vomiting.
On that she was shifted to Govt. Hospital at about 10.00 p.m. on 3.2.2006. She was admitted as inpatient up to 7.2.2006.
She spent about Rs. 5,000/- towards treatment.
Even after discharge she had been consistently suffering from high B.P. and had to get Angiogram and Angioplasty to be done in future. All this was due to negligent treatment rendered by the opposite party doctor, and therefore she claimed Rs. 1 lakh towards compensation, Rs. 50,000/- towards future treatment and costs.
4) The opposite party doctor resisted the case. While admitting that she was 70 years of age however mentioned she was hypertensive. When she came to him on 1.2.2006 with a complaint of burning sensation in her stomach assuming that it was due to acidity, she informed that she had taken tablets Ofloxcin and Ornidazole. On that he took B.P and found that it was 180/100. She also informed that she was using anti-hypertensive drugs. On clinical examination heart, cardio vascular system was found to be normal. The respiratory system was found normal. Her heart beat and pulse rate were normal. She informed that it was due to anxiety. He denied that he ever directed her to undergo ECG, echo test and other tests. The prescription of tablet prozopress XL 2.5 mg is not a heavy dose. It is a prescribed minimal starting dose. The illness suffered by her had nothing to do with Prozopress XL. It might be due to old age. The allegations that the doctors at Gowri Gopal Hospital and Government Hospital informed that she had low B.P could not be true. The treatment that was given at Government Hospital was for Transient Ischemic Attack (TIA). It was not related to Prozopress XL tablet. He never promised to the son of the complainant that he would bear the expenses. He was not aware of the treatment that was given at Government Hospital. She might have been admitted for benign positional vertigo and hypertension with cervical spondylosis. There was no negligence in administering the drugs. Even the text book of Pharmacology and Pharmoco Therapeutics prescribe Prozopress XL 2.5 mg minimum dose for acidity being slow in absorption. There was no negligence on his part and therefore prayed for dismissal of the complaint with costs.
5) The complainant in proof of her case filed her affidavit evidence and examined Dr. Md. Ghouse, MD as PW1 and got Exs. A1 to A12 marked. Refuting her evidence the opposite party doctor examined himself as RW1 and examined R. T. Dhanaraj as RW2 and did not file any documents.
6) The Dist. Forum after considering the evidence placed on record opined that non-informing the said affect of Prozopress XL amounts to negligence. He did not take adequate care while administering the drug and therefore she suffered from side effects, directly attributable to the treatment given by the opposite party, and therefore it directed him to pay Rs. 50,000/- towards compensation and Rs. 10,000/- towards costs besides Rs. 5,054/- towards the actual medical expenses incurred for further treatment.
7) Aggrieved by the said decision, the complainant preferred the appeal F.A. 259/2009 contending that the Dist. Forum did not appreciate the facts in correct perspective. Having opined that there was negligence on the part of opposite party doctor it ought to have awarded compensation of Rs. 1 lakh and Rs. 50,000/- towards further future treatment as prayed by her.
8) Equally the respondent doctor preferred the appeal F.A. 508/2010 contending that the Dist. Forum did not appreciate either facts or law in correct perspective. It ought to have seen that Prozopress XL 2.5 mg is not a heavy dose, nor could be drawn inference from any expert evidence which she alleged in her affidavit evidence. The evidence of Rw2 ought to have been accepted. There is no question of directing her to undergo clinical examination when he could diagnose her problem after observing her earlier medical history. Therefore he prayed that the complaint be dismissed.
9) The points that arise for consideration are :
I. Whether the course of treatment administered by opposite party doctor is not according to approved protocol?
II.
Whether the complainant had suffered any side effects due to drugs prescribed by the opposite party doctor?
III.
Whether the complainant is entitled to any compensation? If so to what amount?
IV.
To what relief?
10) The complainant a 70 years old woman approached RW1 Dr. Rajasekhar, Assistant Professor of Medicine when she was suffering from burning sensation in her stomach due to acidity . RW1 administered prozopress XL 2.5 mg. The complaint is that RW1 ought not to have prescribed prozopress XL 2.5 mg directly without conducting tests like ECH, ECHO, cardiography, TMT etc. he should have started with 0.5 mg, and should be taken on retiring to bed at night time. Since he administered heavy dosage she had adverse effects viz., hypertension related symptoms like headache, drowsiness, dry mouth, weakness, palpitation, nasal blockage, blurred vision etc.
11) She alleges that after taking one tablet of Prozopress XL 2.5 mg on 1.2.2006 along with cyra 20 mg on the next day i.e., on 2.2.2006 at about 7.30 a.m. she suddenly fell down unconsciously due to low blood pressure. Immediately she was shifted to Gowri Gopal Hospital of PW1 at 8.00 a.m. He brought down the B.P to normal stage. She was discharged on 3.2.2006 evening.
12) After her discharge from Gowri Gopal Hospital again she fell down and started vomiting. Then she was shifted to Government General Hospital where RW2 Dr. T. Dhanaraj who treated her from 3/2/2006 to 7/2/2006. All this was due to prescription of heavy dose of Prozopress XL 2.5 mg which amounts to negligence, and therefore she was liable to be compensated for the amounts spent by her towards treatment by PW1 and RW2 besides RW1 and compensation.
13) In order to prove her contention that RW1 ought not to have administered Prozopress XL 2.5 mg examined PW1 Dr. Md. Ghouse who treated her in Gowri Gopal Hospital. PW1 deposed that on her admission CT-Scan, Random Blood Sugar (RBS), Electrocardiogram, Echocardiogram were suggested. He deposed that the complainant had mild left ventricular diastolic dysfunction and rest of the things are normal. At the time when she was joined in the hospital B.P was 90/60 while at the time when she was discharged on the next day the B.P. was 120/70. He diagnosed that she was suffering from Transient Ischaemic Attack meaning that it was a neurological dysfunction. He stated that it was due to atheroscierosis i.e., deposit of fat in arteries or on account of her age high blood pressure cardiac dysfunction. He further stated that she was hypertensive at the time of admission. It was found to be on lower side. Importantly in regard to negligence or deficiency in service attributed to RW1 in administering Prozopress XL he categorically admitted Prozopress XL is an adjunctive drug. Its starting dose is 2.5 mg. XL. The said medicine represents extended release. Plain Parazocin (uncoated) will be absolved into the blood and it may cause the B.P. fall down.
Prozopress XL 2.5 mg is a standard dose and standard prescription.
Finally he stated that on account of administration of Prozopress XL 2.5 mg the person will not become a permanent hypertensive patient. The complainant did not complain of blurred vision, drowsiness, dry mouth, palpitation, nasal block at the time of admission in our hospital or during her treatment in our hospital. The normal B.P. of a person should be 120/80 normal. Hypertensive means more than 140/95 hypotensive is less than 90/60/. If the B.P. of the patient is below 90/60 it will be known as hypotensive. Hence low side of the normal BP is 90/60. I have not given any treatment to the complainant for hypotensive blood pressure.
14) When PW1 her own expert witness did not admit that administration of said drug was improper nor he stated that it was not high dosage it cannot be contended that RW1 was wrong when he administered the said medicine. RW1 who is examined on oath, and reiterated whatever PW1 deposed and according to him there was no negligence on his part in administering the said medicine in the light of the fact that she complained of acidity. RW1 also examined RW2 Dr. T. Dhanraj, Professor in Medicine in Kurnool Medical College who treated the complainant after she was discharged from the hospital of PW1. He stated that she complained vomittings and she was diagnosed as benign peritoneal vertigo with hypertension. He mentioned the treatment given by him was for hypertension, and vertigo. The case sheet is marked as Ex. X1. Even in the chief-examination he stated that complications could be without any reason or at times middle ear diseases cerebral insufficiency i.e., vertebra basilar insufficiency which is insufficient supply of blood to the brain. This can happen to aged persons.. Prozopress XL will be available from 2.5 mg. Hence prescribing Prozopress XL 2.5 mg is not an excessive dosage. Neither her own expert witness PW1 nor RWs1 & 2 doctors deposed that Prozopress XL 2.5 mg is a heavy dose and that administration of that drug would cause inability to walk, drowsiness, dry mouth, weakness, palpitation, nasal blockage, blurred vision etc. Equally the complainant dare not suggest either PW1 her own expert witness or RW2 examined by RW1 that Prozopress XL 2.5 mg cannot be administered without conducting tests like CT-Scan, Random Blood Sugar (RBS), Electrocardiogram, Echocardiogram etc. RW1 has categorically stated that those tests were un-necessary for the ailment suffered by the complainant, more so at the age of 70 years. None of the witnesses had stated that this administration of Prozopress XL 2.5 mg tablet to a 70 years old woman would result in side effects.
15) The complainant alleges that there was negligence on the part of RW1 who prescribed the said drug without any investigations , and without ascertaining the adverse effects. Assuming that he did not mention the possible side effects, where there was none, and a standard and safe treatment for acidity was administered by RW1 a 70 years old lady it cannot be said he was negligent. When there are no side effects no one can accuse RW1 that he started treatment without conducting the investigations. It was not suggested to PW1 that these tests are necessary before prescribing Prozopress XL 2.5 mg. Nothing was made out that there were fluctuations in B.P. as could be seen from the case sheet and the prescription chits, at the time when she was admitted she had B.P. 90/60. It is not in the evidence of PW1 that B.P has fallen down due to administration of said drug that was prescribed by RW1. It was not suggested to PW1 and RW2. All the doctors in one voice, and on oath stated that she was hypertensive and had problem of fluctuation of B.P. On that drugs were administered, and brought it into normalcy.
16) The learned counsel for the complainant relied on text book of Medical Physiology and Pharmacology and Pharmacotherapeutics , 20th edition by R. S. Satoskar, The literature of the manufacturer, the composition of Prazopress XL containing 2.5 mg or 5 mg was mentioned. Ex. A14 is the excerpt from page 269 of Medical Physiology. It reads Prazosin (Minipress) : This drug acts by blocking a receptors selectively. Thus it dilates the arteries (lowering blood pressure) and the veins (reducing the venous return and cardiac output), and it reduces the tone of the internal sphincter of the bladder. It does not cause tachycardia. At page 411 it was mentioned the first dose should be 0.5 mg or less and should be taken on retiring to bed at night, as some patients have adverse reactions such as palpitations, dizziness and even collapse and loss of consciousness following the first dose. It was mentioned that the patient will have loss of consciousness following first dosage that is called first dose effect.
A perusal of which does not suggest that Prazopress XL is an over dosage.
It may be true that if over dosage of certain drugs may cause postural hypotension. However, this is all if we may say so may be in general terms. It may not occur in all cases of patients irrespective of their age, physiological condition and ailments. We may also state herein that the depositions of the witnesses should be read harmoniously not out of context. When RW1 stated that even after 10 hours of administration there is a possibility for postural hypotension in few cases, it does not mean that the complainant had the said effect nor it was the cause for fall. PW1 who was examined by the complainant did not say so that she had fallen and sustained any injury. She had undoubtedly overstated in order to impress that administration of Prazopress XL was wrong. When PW1 and RW2 experts after categorically stated that it was a standard and safe drug and the minimum dosage is 2.5 mg by no stretch of imagination it could be said that it lead to complications. We may also state that PW1 & RW2 who treated the complainant did not state that she had side effects due to administration of Prazopress XL 2.5 mg.
17) The Dist. Forum did not consider the evidence of PW1 & RW2 in this regard. Solely on the ground that after effects were not stated to the complainant, the Dist. Forum opined that there was deficiency in service with which we do not agree. When the doctor was treating the patient for a particular ailment considering all the prescriptions administered the medicine, more so, when she was admitted at 9.30 p.m. the question of conducting various tests when she complains of acidity would not arise.
18) We have perused the entire record and in the light of evidence of PW1 here own expert witness besides RW2 another expert witness who treated the complainant approved administration of Prazopress XL, we do not intend to state that line of treatment given by RW1 in this regard is faulty or that he was guilty of negligent treatment.
19) In the result the appeal preferred by the opposite party F.A. 508/2010 is allowed setting aside the order of the Dist. Forum. Consequently the complaint is dismissed. As a corollary the appeal preferred by the complainant F.A. 259/2009 is dismissed. However in the circumstances of the case there shall be no order as to costs.
1) _______________________________ PRESIDENT
2) ________________________________ MEMBER
3) ________________________________ MEMBER 18/07/2011 *pnr UPLOAD O.K.