State Consumer Disputes Redressal Commission
Dr. Parmod Jain Hospital vs Swarn Singh & Ors. on 18 July, 2017
STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
PUNJAB, CHANDIGARH.
First Appeal No.799 of 2014
Date of institution : 23.06.2014
Date of decision : 18.07.2017
Dr. Parmod Jain Hospital (Vimal Hospital), near Govt. High School
(Boys), Barnala, through Dr. Parmod Jain.
....Appellant/Opposite Party No.1
Versus
1.Swarn Singh father of Manpreet Singh, H.No.B-XIII/1318, Shaheed Bhagat Singh Nagar, near Nanaksar Gurudwara, Barnala.
....Respondent/Complainant
2. Mittal Nursing Home, Gurudwara Ramsar Sahib Road, Dhanaula, District Barnala, through Dr. P.C. Mittal.
3. Civil Hospital, Barnala, through Medical Supdt.
4. New India Assurance Co. Ltd., Branch Office, Barnala, through its Branch Manager.
....Respondents/Opposite Parties No.2 to 4
First Appeal against the order dated 19.05.2014 of the District Consumer Disputes Redressal Forum, Barnala.
Quorum:-
Hon'ble Mr. Justice Paramjeet Singh Dhaliwal, President Present:-
For the appellants : Sh. J.S. Thind, Advocate
For respondent No.1 : Sh. Rishabh Jain, Advocate
For respondent No.2 : None
For respondent No.3 : Ex parte
For respondent No.4 : Sh. R.K. Sharma, Advocate.
First Appeal No.799 of 2014 2
JUSTICE PARAMJEET SINGH DHALIWAL, PRESIDENT
The instant appeal has been filed by the
appellant/opposite party No.1 against the order dated 19.05.2014 passed by District Consumer Disputes Redressal Forum, Barnala (in short, "the District Forum"), whereby the complaint filed by respondent No.1/complainant, under Section 12 of the Consumer Protection Act, 1986, was allowed and opposite party No.1 was directed to pay a consolidated compensation of ₹5,00,000/-, with liberty to opposite party No.1 to recover the amount from the Insurance Company, by filing a Civil Suit or by approaching the Insurance Company, if he desires so.
2. It would be apposite to mention that hereinafter the parties will be referred, as have been arrayed before the District Forum.
Facts of the Complaint
3. Brief facts, as averred in the complaint, are that the complainant is an illiterate person and working as a labourer. His son namely Manpreet Singh, at the time of his birth, was a normal baby and grew well. On 28.12.2009, at the age of 4 months, the son of the complainant suffered from fever and was taken to opposite party No.1-Hospital on the same day. After examination, Dr. Parmod Jain informed the complainant that the child needs indoor treatment and admitted the child in his Nursing Home, known as Dr. Parmod Jain Hospital. The doctors at the said First Appeal No.799 of 2014 3 hospital started giving the medicine to the son of the complainant after admission. The complainant deposited ₹4,000/- with opposite party No.1-Hospital on various dates for treatment of his son. The child remained under the treatment of Dr. Parmod Jain in his hospital, as the complainant was informed that Dr. Parmod Jain was a child specialist and all necessary facilities were available in his hospital. After few days, the condition of the child turned from bad to worse and he developed swelling on the face and many other complications arose. Dr. Jain continued to assure the complainant that his son would be treated and the weight of the child was increasing and there was nothing to worry. On 09.02.2010, the child developed symptoms of seizures and had difficulty in breathing. The complainant complained to the doctor about the condition of the child, but he was assured that this is normal in children and the child would improve in due course and administered medicines upto 19.02.2010. After three days, the complainant was told by opposite party No.1 that he had done his best but the child was not improving, so the complainant should consult some other doctor and take the child to other hospital. Thereafter, the child was taken to Mittal Hospital and Nursing Home, Dhanaula, but as the condition of the child became serious, so he was referred to Civil Hospital, Barnala. The doctors at Civil Hospital, Barnala admitted the child and started treating him. The child remained under treatment there till 02.03.2010. Ultimately, they further referred the child to Rajindra Hospital, Patiala on the First Appeal No.799 of 2014 4 same day. The child remained under the treatment of Dr. Prabhat Shobha, Professor Incharge, Unit No.II of Pediatrics Department. The doctors of Rajindera Hospital did their best to treat the child, but his condition did not improve there too. Thereafter, taking into consideration the non-improvement of the child, the doctors of Rajindra Hospital referred the child to PGI on 02.04.2010. The child was admitted in PGI on the same day. The complainant was informed that the condition of the child was critical and anything could happen. The complainant was asked to bring all the packings of medicines administered to the child by Dr. Parmod Jain as well as at other hospitals. It was recorded in the PGI report that the child was suffering from "cushing syndrome due to exogenous administration of steroids" by Dr. Parmod Jain. The steroids were only administered by Dr. Parmod Jain and not at any other hospital. In fact, opposite party No.1 was responsible for the bad condition of the child, due to excessive administration of steroids, without any pre-investigation to safeguard the child from the side effects of the steroids. Opposite party No.1 had not prescribed the medicines, in accordance with the settled medical practices and the doses were not in accordance with the standard; as a result of which the condition of the child became worse. The child remained in PGI as indoor patient upto 17.04.2010, under the treatment of Dr. Meenu Singh and Dr. Devi Dayal, assisted by Residents of Dr. Kirti and Dr. Mani. At PGI the condition of the child started improving and ultimately he was discharged First Appeal No.799 of 2014 5 therefrom. However, the child was still having side effects of the medicine 'Stemin' containing Betamethosone, administered by Dr. Parmod Jain; which resulted into various complications associated with Corticosteroids. The act and conduct of opposite party No.1 amounted to medical negligence. It was further pleaded that when the steroids administered to a patient, the doctor is required to weigh the benefits and risks of administering the same, but Dr. Parmod Jain utterly failed to observe the same and was negligent in discharging his professional duty, which put the life of the infant at stake and its side effects may continue throughout his life. It was further averred that the complainant had to spend ₹2,00,000/- towards the cost of treatment and filing the complaint. The act and conduct of opposite party No.1 amounted to medical negligence. Accordingly, the complainant approached the District Forum, seeking the following directions:
i) to pay ₹2,00,000/- towards cost of treatment of the child;
ii) to pay ₹10,00,000/-, as damages suffered by the child on account of wrong treatment by the opposite party;
iii) to pay ₹5,00,000/- on account of mental tension and harassment suffered by the complainant; and
iv) to pay ₹5,000/-, as litigation expenses.
Defence of the Opposite Parties
4. Upon notice, opposite parties No.1, 3 & 4 appeared before the District Forum and filed their independent replies to the First Appeal No.799 of 2014 6 complaint, whereas opposite party No.2 did not appear despite service and was proceeded against ex parte.
5. Opposite party No.1, in its reply, raised certain legal objections that the complaint is not maintainable and he has no locus standi to file the complaint. The complainant is estopped from his act and conduct from filing the present complaint. The District Forum had no jurisdiction to try and entertain the complaint. The complainant has filed the complaint in order to blackmail opposite party No.1 and opposite party No.1 is entitled to compensatory costs of ₹25,000/- from the complainant. On merits, admission of the child in opposite party No.1-Hospital and payment of ₹4,000/- by the complainant were admitted. It was pleaded that the child was suffering from fever, cough and had difficulty in breathing. On examination by opposite party No.1, he immediate admitted the child as indoor patient and started treating him and administering the medicines. In fact, the complainant approached opposite party No.1 on 28.12.2009 and the child was treated as an outdoor patient. Opposite party No.1 is a well qualified and experienced medical practitioner. He is MBBS and DCH (with distinction) in child specialty and also served at Civil Hospital, Barnala for two years. He has more than 28 years of private practice to his credit. It was further pleaded that opposite party No.1 was insured as Professional Indemnity Doctor for ₹10 lacs. It was pleaded that at time of admission of child, the provisional diagnosis was "acute bronchitis/ bronchiolitis/allergic First Appeal No.799 of 2014 7 bronchitis", for which the child was given outdoor treatment by way of antibiotic, bronchodilator, antihistaminic, paracetamol and steroid (betamethasone 0.33 Mg per day in two divided doses) for five days till 01.01.2010. On examination on 04.01.2010, when the complainant approached opposite party No.1, the child was normal and fine, as mentioned in outdoor prescription slip. The complainant again brought the child to opposite party No.1 on 08.01.2010 with complaint of fever, cough and difficulty in breathing and the child was given the same treatment, as mentioned above. On 17.01.2010, the complainant again brought the child to opposite party No.1 and on examination, the child was found improving and the complainant was told to continue the same treatment, with tapering dose of steroid (betamethasone 0.17 mg per day in two divided doses) for six days. On 23.01.2010, after examination, the dose of steroid was further reduced to, betamethasone 0.08 mg per day in two divided dose, for three days. On 30.01.2010, the complainant again brought the child to opposite party No.1, with complaint of fever, cough and difficulty in breathing and the doctor advised him to undergo investigation. However, the complainant denied to do the same, due to paucity of money and requested that the child should be given treatment on the same day, on the ground that the child would undergo investigation after a few days. Thus, the child was given treatment as outdoor patient, in the form of antibiotic, bronchodilator, antihistaminic, paracetamol and steroid First Appeal No.799 of 2014 8 (betamethasone 0.33 mg per day in two divided doses) for four days, till 2.2.2010 and was asked to visit opposite party No.1 for investigation and follow-up on 03.02.2010, but the complainant did not turn up on that day and he only brought the child on 07.02.2010 and was again advised to undergo investigation of the child. He again denied to do so and requested that they would come on the next day. On 08.02.2010, child was investigated and found with Haemoglobin-10.4 gm, TLC-17800 (normal range- 4000-11000), MP-Negative; ascribing to raised TLC, opposite party No.1 advised him for indoor treatment of the child immediately. He again denied to do the same and requested that they would come on the next day for admission. Therefore, the child was treated with IV Antibiotic (Montaz 250 mg and Dexamethasone 0.25 ml). On 09.02.2010, child was admitted for indoor treatment and was treated with paracetamol, IV antibiotic, bronochodilator, antihistaminic and steam inhalation. On 10.2.2010, after investigation, the child was found with TLC-15900 and was continued with the same treatment. During the stay in the hospital, child was improving, which is evident by investigation repeated on 14.02.2010, as per which TLC came down from 17800 to 11900. Further on 14.02.2010, the complainant told that he wanted to get his son discharged immediately. Opposite party No.1 informed him that the child was improving and same treatment should be continued, but he left the hospital, along with his son, as 'Left Against Medical Advice' on the same day i.e. First Appeal No.799 of 2014 9 14.02.2010 and, thus, the child was discharged and the complainant was given discharge summary and treatment chart. It was further pleaded that two episodes of seizures, mentioned in the discharge summary of PGI, occurred at Rajindra Hospital, Patiala, as is evident from its discharge summary and not at opposite party No.1-Hospital. The child was never given various medicines up to 19.02.2010, because the complainant himself got discharged his son on 14.02.2010, against medical advice. It was further pleaded that Dr. P.C. Mittal of Mittal Hospital and Nursing Home, Dhanaula is MBBS, DOMS, as is evident from the prescription slip. He is an eye specialist and was not authorized and competent to treat pediatric medicine patients. It was further pleaded that possibly, the child might have been given desi treatment, which could contain steroids or/and such medicines, as a general practice with most of the people. It was further averred that the complainant has alleged that the child is still undergoing treatment, but the details of the said treatment are not given in the complaint. The complainant has intentionally not attached the discharge summary of opposite party No.1 with the complaint. All other allegations of the complainant were denied and it was prayed that the complaint be dismissed with costs.
6. Opposite party No.3, in its reply, raised similar legal objections, in addition to the objection with regard to non-joinder and mis-joinder of necessary parties. On merits, it was pleaded First Appeal No.799 of 2014 10 that the child, Manpreet Singh, was brought to Emergency Ward of Civil Hospital, Barnala and the doctors immediately admitted him and started treatment. The child remained under their treatment upto 02.03.2010, when he was referred to Rajindra Hospital, Barnala. It was further pleaded that no unwarranted and excessively steroids were ever administered to the child by the doctors at Civil Hospital, Barnala. Opposite party No.2 is not liable to pay any compensation to the complainant. It prayed for the dismissal of the complaint against it, with costs.
7. Opposite party No.4, in its reply, pleaded that it was unable to file proper reply regarding the insurance of Dr. Parmod Jain for the period 28.12.2009 to 27.12.2010 for want of particulars of the insurance. Dr. Parmod Jain failed to disclose the number of insurance policy and to produce the same. The allegations of the complainant were denied, for want of knowledge. There was no deficiency in service on the part of opposite party No.4. Thus opposite party No.4 is not liable to indemnify the loss to Dr. Parmod Jain, in case the complaint was allowed. It prayed for the dismissal of the complaint.
8. The complainant filed rejoinder to the reply filed by opposite party No.1, reiterating the averments of the complaint and controverting the pleadings of opposite party No.1. First Appeal No.799 of 2014 11 Finding of the District Forum
9. The parties produced evidence in support of their respective averments before the District Forum, which after going through the same and hearing learned counsel on their behalf, allowed the complaint, vide impugned order. Hence, this appeal. Contentions of the Parties
10. I have heard learned counsel for the parties, except respondent No.1/complainant as none appeared on his behalf at the time of arguments and respondent No.2, who was proceeded against ex parte. I have also carefully gone through the records of the case as well the written arguments already submitted on behalf of the opposite party No.1 and the complainant.
11. In addition to the written arguments, learned counsel for appellant/opposite party No.1 vehemently contended that the appellant is MBBS and DCH (with distinction) in child specialty and also served at Civil Hospital, Barnala for two years. He has more than 28 years of private practice to his credit. He was insured as Professional Indemnity Doctor for ₹10 lacs w.e.f. 07.05.2009 to 06.05.2010 with opposite party No.4. The complainant, with his son, approached opposite party No.1 on 28.12.2009, with complaint of fever, cough and difficulty in breathing and the child was treated as an outdoor patient. He found the provisional diagnosis as "acute bronchitis/ bronchiolitis/allergic bronchitis". The condition of the child slightly improved by the treatment of opposite party No.1, but the complainant requested and insisted First Appeal No.799 of 2014 12 that the child should be discharged and be given treatment in OPD, due to unavoidable family circumstances and on his request, the patient was discharged and handed over to him. The complainant paid ₹4,000/- to opposite party No.1 on various dates. The child was given outdoor treatment by way of antibiotic, bronchodilator, antihistaminic, paracetamol and steroid (betamethasone 0.33 Mg per day in two divided doses) for five days till 01.01.2010. The patient was prescribed 10 drops of stemin (Betamethasone) two times a day, as per outdoor treatment slip, Annexure-1. The child was again brought to opposite party No.1 on 08.01.2010 with complaint of fever, cough and difficulty in breathing and the child was given the same treatment, as mentioned above for next 8 days. On examination, the child was found improving and the complainant was told to continue the same treatment, with tapering dose of steroid (betamethasone 0.17 mg per day in two divided doses) for six days. On 23.01.2010, after examination, the dose of steroid was further reduced to, betamethasone 0.08 mg per day in two divided dose, for three days. Similarly, the child was given treatment on 30.01.2010 and 07.02.2010. On 08.02.2010, child was investigated and found with Haemoglobin-10.4 gm, TLC-17800 (normal range-4000-11000), MP-Negative; ascribing to raised TLC, OP-1 advised CC for indoor treatment immediately. Similarly, the patient was given treatment on 09.02.2010 and 14.02.2010, as described above in the reply of opposite party No.1. It was further First Appeal No.799 of 2014 13 contended that the complainant got discharged his son on 14.02.2010 from opposite party No.1-Hospital as "Left Against Medical Advice". There was no swelling on the face of the patient or seizures during his stay at opposite party No.1-Hospital from 09.02.2010 to 14.02.2010. The seizures occurred in Rajindra Hospital, as mentioned in the discharge summary of PGI, Annexure-5. It was further contended that the investigations carried out in Rajindra Hospital showed elevated LgE, which further reinforced the fact that the patient was suffering from allergic bronchitis, treatment of which demands steroids. The local anaphylactic reactions (atopic allergy) to extrinsic antigens (allergens), such as pollen, animal danders, mites in house dust and absorbed foodstuffs occur more frequently. As per record of Rajindra Hospital, blood counts showed increased number of Eosinophils (more than 450 per cubic mm of blood). Allergic diseases are often associated with increased number of Eosinophils circulating in the peripheral blood. The patient needed steroids (Betamethasone) and the same were given in the standard range. About the steroid (Betamethasone) Betamethasone has highly selective glucocorticoid and no mineralocorticoid activity hence hypertension, salt and water retention and hypokalemia are rare with Betamethasone. The disease mentioned in the discharge summary of PGI are unlikely to be caused with the steroid (Betamethasone) prescribed by the deponent. There was no negligence on the part of opposite party First Appeal No.799 of 2014 14 No.1 in treating the patient and the impugned order passed against him is liable to be set aside.
12. Per contra, in addition to the written arguments submitted on behalf of respondent No.1/complainant, learned counsel contended that the son of the complainant was brought to Dr. Parmod Jain i.e. Vimal Hospital for treatment of cough, cold and fever on 28.12.2009, who after examination immediately started administering various drugs. However, the condition of the patient kept on deteriorating and he developed various complications after the wrong treatment given by Dr. Parmod Jain. Seeing no improvement, opposite party No.1 referred the patient to Civil Hospital, Barnala on 19.02.2010, from where he was referred to Rajindra Hospital, Patiala and ultimately he was admitted in PGI where he remained admitted from 02.04.2010 to 17.04.2010. The doctors diagnosed the son of the complainant to be suffering from Cushing's syndrome due to exogenous steroids induced. Opposite party No.1 concealed the Indoor Hospital Record of the patient and he failed to get the bare minimum tests of the patient conducted. No consent letter has been produced by opposite party No.1, to prove that the family members of the patient were informed about the side effects of the steroids etc. It was further contended that corticosteroids are not the first line of therapy as they are immunosuppresant's thereby lowering the immunity of the body and ability to fight infections. There is no explanation from the side of opposite party No.1 regarding the side First Appeal No.799 of 2014 15 effects of steroids given at the first instance. By prescribing steroids for long period, the appellant exposed the child to avoidable complications, which led to deterioration of his condition. The appellant/opposite party No.1 did not adopt the standard line of treatment. The entire evidence produced by opposite party No.1 refers to the condition of acute asthma, whereas Manpreet Singh was never diagnosed to be suffered from asthma. Opposite party No.1 repeated the stemin in the noon i.e. after six or eight hours and no explanation has come for omitting the dose at night. He failed to explain, if after first 6 to 8 hours, the plasma level of betamethasone had gone so low that he had to repeat the dose. It is proved that opposite party No.1 prescribed 10 drops TDS and he is trying to take benefit of his poor handwriting. In reply to the interrogatory at Sr. No.33, the appellant/opposite party No.1 agreed that Cephalosporin could cause encephalopathy. No effort was made by him to get the serum biluribin level tested to rule out the encephalopathy in spite of the fact that the child was continuously being administered cephalosporin for long period and was suffering from adverse reaction of the same. Discharge summary of PGI reveals that the child suffered from metabolic disorders and became hypertensive and epileptic due to wrong and negligent treatment of opposite party No.1. It was recorded in the PGI report that the child was suffering from "cushing syndrome due to exogenous administration of steroids" by Dr. Parmod Jain The District Forum has rightly held the appellant/opposite party First Appeal No.799 of 2014 16 medically negligent and there is no ground to interfere with the impugned order. The appeal is liable to be dismissed. Consideration of Contentions
13. I have given thoughtful consideration to the contentions raised by the learned counsel for the parties.
14. The only question in this appeal, which arises for consideration, is with regard to the alleged overdose of steroids prescribed by opposite party No.1 to the infant of three and a half month. Detailed arguments have been raised with reference to the medical literature, which has been annexed along with the written arguments submitted on behalf of opposite party No.1, to contend that he was not negligent and the dose of steroid prescribed by him was within the standard medical practice. Earlier, this Commission had reserved the verdict in this case, but while dictating the judgment, this Commission realized that this matter was required to be referred to the medical expert body. Accordingly, the matter was referred to PGI, Chandigarh, vide order dated 11.04.2017, to constitute a Board of Doctors and submit the opinion with regard to the alleged medical negligence and deficiency in service on the part of treating doctor i.e. Dr. Parmod Jain (opposite party No.1). Copies of all the medical records available on this file, with regard to treatment of Manpreet Singh, infant, taken from various hospitals, including opposite party No.1, were sent to the Director, PGI, Chandigarh in that regard. After considering the said medical record and other First Appeal No.799 of 2014 17 records, the PGI, Chandigarh sent the report of the Medical Board dated 13.06.2017 to this Commission, which reads as under:
Report of Medical Board A Medical Board of the following members was constituted, vide order No.EV (9) PGI-MS/MA-63/2017 dated 30.05.2017 in pursuance of request received from Registrar, State Consumer Redressal Commission, Punjab for First Appeal No.799 of 2014 titled as "Dr. Parmod Jain Hospital vs. Swarn Singh and Ors.":-
1. Prof. Deepak Bansal Chairman Deptt. of Pediatrics, Advanced Pediatric Centre, PGIMER, Chandigarh.
2. Dr. Sanjay Verma, Addl. Prof. Member Deptt. of Pediatrics, Advanced Pediatric Centre, PGIMER, Chandigarh.
3. Dr. Rakesh Kumar, Addl. Prof. Member Deptt. of Pediatrics, Advanced Pediatric Centre, PGIMER, Chandigarh.
4. Dr. Aditi Mehra, Senior Resident, Convener Dept. of Hospital Administration, PGIMER, Chandigarh.
The medical records provided to the Board were studied in detail by all the members. The medical literature related to the case was referred to as well. The hospital admission file at PGIMER, Chandigarh and follow up record of the Pediatric Endocrinology Clinic file were retrieved for reference.
Following detailed perusal of the records and documentations, the medical board has made the following observations:
First Appeal No.799 of 2014 18
1. The patient had respiratory illness at 4 months of age.
The most common cause for respiratory distress at 4 months of age is viral bronchiolitis. As per the standard line of treatment, steroids do not have a role in such cases initially or during the first episode. Steroids are indicated only after multiple such episodes are observed, associated with wheezing. Even in cases with recurrent episodes of wheezing (suggesting a diagnosis of bronchial asthma), nebulized steroids are preferred over systemic steroids (e.g. oral). According to the standard line of treatment, a relatively lower potency steroid (e.g. prednisolone or hydrocortisone) is the preferred choice in bronchial asthma. Betamethasone is a long-acting, highly potent glucocorticoid, which is not recommended for treatment of such illnesses. In addition, in such respiratory illnesses, where oral steroids are deemed necessary, the recommended duration is typically less than a week. In view of the above, it appears that the doctor (Dr. Parmod Jain) has not shown due diligence in prescribing steroids for the given indication.
2. The clinical profile of the patient, including hypertension (requiring anti-hypertensive medications), puffiness of the body, hirsutism (excessive hair) and a reversibility of these symptoms in the follow-up suggests a diagnosis of iatrogenic Cushing's Syndrome. Patient had been followed up with several hospital visits, in the Pediatric Endocrinology Clinic at PGI, Chandigarh from 5.5.2010 to 23.5.2012. During this follow-up, gradually, all the First Appeal No.799 of 2014 19 medications were stopped, suggesting that the Cushing's Syndrome was reversible and thus not related to any intrinsic endocrine or neoplastic disorder. The documents clearly suggest that the Cushing's Syndrome was due to an iatrogenic administration of steroids.
To result in Cushing's Syndrome the steroid has to be administered over a lengthy duration of several weeks. However, it is unclear from the records as to who is responsible for the prolonged usage of betamethasone by the patient. It is possible, that various factors could be contributing to the longer duration of administration of steroid in this case, including poor awareness/understanding and low literacy/socio-economic profile of the family, sub-optimal communication by the doctor and a relatively casual approach towards prescription of steroids.
3. As per literature review, use of Clobetasol is not recommended below the age of 12 years. However, application of Clobetasol to the diaper area for merely two days is unlikely to cause any harm. The prescription of a potent steroid like Clobetasol to the infant for the given indication was unnecessary and avoidable.
4. The patient last visited the Pediatric Endocrinology Clinic on 23.5.12. The hospital records suggest that the patient was doing well with normal weight, height and a normal blood pressure.
Following detailed deliberations the medical board concludes that:
First Appeal No.799 of 2014 20
a) The steroid (oral betamethasone) was inappropriately prescribed to the infant by Dr. Parmod Jain.
b) The administration of betamethasone led to Cushing's Syndrome (an adverse effect of steroid administration).
c) The onus of prolonged duration (necessary to result in Cushing's Syndrome) of administration of steroid is difficult to ascertain.
d) At the last follow up at PGIMER, Chandigarh, the patient was off medications and there were apparently no major ongoing health problems observed or reported.
15. The perusal of report of the PGI Medical Board clearly reveals that it was Dr. Parmod Jain, who inappropriately provided the steroids to the infants. The administration of Betamethasone led to cushing's syndrome, an adverse effect of steroids administration. Even it has been mentioned in the report that use of Clobetasol is not recommended below the age of 12 years. However, its application to diaper area for merely two days is unlikely to cause any harm. The prescription of a potent steroid like Clobetasol to the infant for the given indication was unnecessary and avoidable.
16. The medical profession is considered as a noble profession, as it helps in preserving life. I believe that life is God given. Thus, a doctor figures in the scheme of God, as he stands to carry out His command. When a patient approaches a doctor, he believes that the doctor or the concerned hospital will provide First Appeal No.799 of 2014 21 medical treatment with all the knowledge and skill at their command, but sometimes the doctors forget their duty and they do not discharge their obligation, which essentially results in medical negligence. The relationship of the doctor and the hospital with the patient is in the nature of a contract and the following things are necessary to be kept in mind before giving the treatment to the patient:
a) duty of care in deciding what treatment to give;
b) duty of care in administration of the medicine;
The breach of any of these duties may cause action under medical negligence.
17. Now looking into the facts of the present case, opposite party No.1 kept on prescribing medicine i.e. steroids to the infant for a sufficient long period. Such a dose was not required to be prescribed and the dose of Betamethasone prescribed by opposite party No.1 was not proper dose, as a result there was diagnosis of Cushing's Syndrome. The side effects of steroids are to be seen later in life, which include the following things:
"Acne, clumsiness, dizziness, facial flushing, general body discomfort, headache, increased appetite, increased sweating, lightheadedness, nausea, nervousness, pain, swelling, redness at the injection side, sleeplessness, upset stomach etc." First Appeal No.799 of 2014 22
Betamethasone should not be used in new born or infants. It may cause serious and sometimes fatal nervous system problem and other side effects. Corticosteroids may affect growth rate in children and teenagers in some cases. They may need regular growth check, while using Betamethasone. Betamethasone should be used with extreme caution in children. In the present case, after administration of Betamethasone, the baby suffered pain and discomfort, as a result of protected healing process at the hands of the appellant, due to prescription of overdose steroids.
18. Still further, there is no evidence brought on record by opposite party No.1 to prove that the ward of the infant was informed about the possible side effects of the medicine. There is no document on record to show that the attendants/family members of the infant were informed about the complications/side effects of the administration of the said steroids or any informed consent was obtained from them.
19. Now, coming to the other major difficulty, on account of which the doctor cannot be spared i.e. the improper dose of steroids, which resulted into Cushing's Syndrome. Although the medical literature has been referred, but the expert body of the PGI has given its opinion against opposite party No.1. In similar set of circumstances, in case Balram Prasad (DR.), Advanced Medicare & Research Institute Ltd., Dr. Baidyanath Haldar, Dr. Sukumar Kukherjee Vs. Dr. Kunal Saha & Ors. and Dr. Kunal Saha Vs. Dr. Sukumar Mukherjee & Ors. IV (2013) CPJ 1 (SC), First Appeal No.799 of 2014 23 Hon'ble Supreme Court held in Paras No.73 & 111 (relevant portion) as under:
"This Court has also made it clear that the excessive use of the medicine by the doctor was out of sheer ignorance of basic hazards relating to the use of steroids as also lack of judgment. No doctor has the right to use the drug beyond the maximum recommended dose.
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We are therefore inclined to reiterate the findings of this Court regarding the liability of Dr. Mukherjee in Malay Kumar Ganguly's case which read as under:
"159. When Dr. Mukherjee examined Anuradha, she had rashes all over her body and this being the case of dermatology, he should have referred her to a dermatologist. Instead, he prescribed "depomedrol" for the next 3 days on his assumption that it was a case of "vasculitis". The dosage of 120 mg depomedrol per day is certainly a higher dose in case of a TEN patient or for that matter any patient suffering from any other bypass or skin disease and the maximum recommended usage by the drug manufacturer has also been exceeded by Dr. Mukherjee. On 11-5-1998, the further prescription of depomedrol without diagnosing the nature of the disease First Appeal No.799 of 2014 24 is a wrongful act on his part. 160. According to general practice, long acting steroids are not advisable in any clinical condition, as noticed hereinbefore. However, instead of 159 Page 160 prescribing a quick-acting steroid, the prescription of a long-acting steroid without foreseeing its implications is certainly an act of negligence on Dr. Mukherjee's part without exercising any care or caution. As it has been already stated by the experts who were cross-examined and the authorities that have been submitted that the usage of 80-120 mg is not permissible in TEN. Furthermore, after prescribing a steroid, the effect of immunosuppression caused due to it, ought to have been foreseen. The effect of immunosuppression caused due to the use of steroids has affected the immunity of the patient and Dr. Mukherjee has failed to take note of the said consequences."
20. Similarly, in case Poonam Verma v. Ashwin Patel & Ors. II (1996) CPJ 1 (SC), the issue arose with regard to prescribing the medicine and it was held that once the opinion of the expert is available, then certainly the Court has no option, but to rely upon the same.
21. It is also important to note that opposite party No.1, in his cross-examination himself admitted that as per Ex.C-17 and Ex.C-18, the child was suffering from Cushing's Syndrome and the First Appeal No.799 of 2014 25 same was due to exogenous steroid induced. Dr. Parmod Jain took a plea that cortico steroids can be given as first line of treatment to the patient of asthma, but in his cross-examination he admitted that he never diagnosed the child to be suffering from asthma. It stands proved that the condition of the child worsened due to wrong and improper line of treatment given by opposite party No.1, due to which the child and his parents suffered great mental tension and harassment. The District Forum has dealt with the controversy between the parties in detail and rightly fastened the liability upon opposite party No.1.
22. The District Forum gave liberty to opposite party No.1 to recover the amount of compensation from the Insurance Company, by filing a Civil Suit or by approaching the Insurance Company. It is relevant to mention here that there is no need to file any civil suit for recovery of insured amount by opposite party No.1. Dr. Parmod Jain, opposite party No.1 was insured with opposite party No.4-New India Assurance Company Limited, vide policy Ex.R-28, for the period 07.05.2009 to midnight of 06.05.2010. The complainant got treatment of his son from opposite party No.1 from 28.12.2009 to 19.02.2010. Thereafter, the patient remained under treatment at various hospitals and lastly he took treatment from PGI, Chandigarh, from where he was discharged on 17.04.2010. It was due to wrong prescription of overdose steroids by opposite party No.1 that the condition of the patient deteriorated and he was to be taken to various hospitals First Appeal No.799 of 2014 26 during the said period. Under the above said policy, the insured amount for 'Any One Accident' is mentioned as ₹2,50,000/-. The District Forum has awarded compensation of ₹5,00,000/- in favour of the complainant. So, opposite party No.4-Insurance Company is liable to pay the compensation amount to the extent of ₹2,50,000/- to the complainant and the remaining amount is payable by opposite party No.1. Except this observation/modification, the impugned order is legal and valid and there is no ground to interfere with the same.
23. In view of my above discussion, the appeal is dismissed and the impugned order is upheld, subject to above said observation/modification.
24. The appellant had deposited a sum of ₹25,000/- at the time of filing of the appeal. He deposited another sum of ₹2,25,000/-, vide receipt dated 01.08.2014, in compliance of the order dated 07.07.2014. Both these sums be remitted by the registry to the District Forum, after the expiry of 45 days of the sending of certified copy of the order to them. Respondent No.1/complainant may approach the District Forum for the release of the above amounts and the District Forum may pass the appropriate order in this regard. It is made clear that the interest, which accrued on the above said total amount of ₹2,50,000/-, be also remitted to the District Forum and opposite party No.1 may also seek refund of that amount from the District Forum. First Appeal No.799 of 2014 27
25. The appeal could not be decided within the statutory period due to heavy pendency of court cases.
(JUSTICE PARAMJEET SINGH DHALIWAL) PRESIDENT July 18, 2017.
(Gurmeet S)