State Consumer Disputes Redressal Commission
Mrs.Anuradha Sridhar vs Dr.Umesh M. Thakkar on 19 July, 2010
CONSUMER DISPUTES REDRESSAL COMMISSION CONSUMER DISPUTES REDRESSAL COMMISSION MAHARASHTRA STATE, MUMBAI Date of filing : 10/11/1998 CONSUMER COMPLAINT NO. 418 OF 1998 Date of order : 19/07/2010 Mrs.Anuradha Sridhar R/at 401, Sheel Jeet Apartments, Natwar Nagar Road No.5, Jogeshwari (E), Mumbai-400 060. Complainant V/s. Dr.Umesh M. Thakkar Satyam Polyclinic A/101, Vertex Vikas, Andheri-Kurla Road, Andheri (E), Mumbai-400 069. Opposite Party Quorum : Shri P.N. Kashalkar, Honble Presiding Judicial Member
Mrs.S.P. Lale, Honble Member Appearance :
Ms.Archana Sabnis, Advocate h/f. Mr.Shirish Deshpande, Advocate for the complainant.
Mr.Raja Thakre, Advocate for the O.P.
-: ORDER :-
Per Shri P.N. Kashalkar, Honble Presiding Judicial Member The complainant has filed this complaint against Dr.Umesh M. Thakkar alleging medical negligence on the part of doctor. It appears that she herself drafted the complaint. So, she has narrated the incident and questioned the treatment given by doctors and in the process she has alleged medical negligence against him. According to complainant, her husband Subramaniam Sridhar, aged 42, died suddenly on 25/02/1997 and in the medical certificate of death, the cause of death has been given as terminal cardio-respiratory failure, due to acute pyogenic meningitis, with brain stem encephalitis and acute right otitis media. According to the complainant on 20/02/1997her husband went to Dr.Umesh Maganlal Thakkar, Consulting Physician and Cardiologist at Satyam Polyclinic, A/101, Vertex Vikas, Andheri-Kurla Road, Andheri (E), Mumbai-400 069 also practicing at Parvish Nursing Home, Telli Galli, Andheri (E), Mumbai, since her husband was having acute pain on the right side of the ear. He prescribed Tablets Febrex Plus (1 tablet thrice a day for 5 days) and Tablets Therragren-M (1 tablet daily). Her husband was asked to take blood test on these days. Accordingly, blood test was taken on these days. According to the doctor, there was no indication of malaria. On the next day, her husband had to go to Baroda for official work. Before returning to Mumbai, he telephoned her from Baroda and informed that he would be returning late at night and he was feeling feverish and was having earache. The next day, he went to meet Dr.Thakkar at Parvish Nursing Home and Dr.Thakkar prescribed Tablets of Vibazine-DT (100 mg) and Ear drops Otekae and Croydoxin FM for next two days. His prescription says that there is fever and chills, sore throat, pain in right ear. Next day being Sunday, her husband called doctor in the morning, who asked him to meet him in the Clinic. Doctor asked him to continue same medicines and he burst boil which he found in the ear. But, her husbands earache continued through out the day and in the evening he would become very feverish. This pattern continued till Monday evening when his fever became quite high and he was shivering badly. Her husband and his father went to see Dr.Thakkar at Satyam Polyclinic. Dr.Dalal was also available in the Clinic. Dr.Dalal had written on the note that right ear, inflammation, mastoid tenderness, acute otitis media and mastoidities and recommended some new medicines to be taken for 5to6 days. When her husband returned home at 9.00 p.m. he was shivering badly and was unsteady in walking. She gave one tablet out of three in an empty stomach after he started getting delirious around 9.30 p.m. He had severe headache at about 10 p.m. He started jabbering, talking incoherently and not recognizing anyone, at 10.30 p.m. she called doctor and told him her husband was having delirium. Dr.Thakkar simply told her to give him one Valium to help him sleep. He did not worry to come to her house and to check him. Despite giving valium her husband continued to talk incoherently, tossing and turning. Then she decided to take him to Parvish Nursing Home. She tried to make him stand, but he fell on ground and lay there. With the help of their driver, some how she put him in his bed and he slept very uneasily. At
2.00 a.m. of 25/02/1997 he became very restless and with the help of six people from the building, she lifted him and took him to Parvish Nursing Home, where he was admitted at 2.30 a.m. Her father-in-law and his driver were present at the Clinic. Assistant doctor after checking temperature and instructed the nurse to administer injections and went away. Only the nurse was there to look after the patient. No intimation was passed on to Dr.Thakkar about the condition of her husband. Though he was family doctor for 10 years and though he knew the condition of her husband being very critical, doctor came to the Nursing Home around 9.00 a.m. after 7 hours since admission of her husband in the Hospital. In the early morning her husband went into coma and when doctor did lumber puncture in the morning, they found that spinal fluid which normally should be clear was turbid, indicating an infection. They ruled out brain hemorrhage but suspected a lot of infection in the brain. At about 10.00 a.m. she went to Nursing Home found her husband lying in the bed, in coma with breathing difficulty. He was having great difficulty in breathing around 11.00 a.m. They wanted to transfer her husband to some bigger hospital having M.R.I. facility and ambulance was arranged at 2.00 p.m. by which time her husband breathing was quite bad. When he was being taken into the ambulance at about 2.15 p.m. her husband passed away before reaching Bombay Hospital, when ambulance was between Mahim and Worli between 3.00 to 3.30 p.m. on 25/02/1997. The complainant strongly feels that she would not have lost her husband, if the attending doctor had made an early diagnosis of the cause of illness and acted promptly. She alleged medical negligence on the part of Dr.Thakkar/O.P. According to her following are the reasons why she has drawn conclusion that there was gross negligence on the part of O.P./Doctor :-
1. Dr.Thakkar has been our family doctor for the past 10 years and was fully aware of my husbabds health, habits and body resistance.
2) Starting from 20th February, my husband had gone to Dr.Thakkar complaining of severe headache, high temperature and shivering.
3) The boil in the ear, which caused a lot of pain coupled with above symptoms should have given enough indication that there was severe infection.
4) When my husband became delirious on 24th night, Dr.Thakkar asked me to give him Valium when contacted. Considering that he was our family doctor for over 10 years, he should have come to examine the condition of my husband himself that night instead of prescribing valium. Incidentally, Dr.Thakkar lives close by to our residence.
5) In spite of knowing the serious condition of my husband on 24th night, itself, Dr.Thakkar showed up at the Nursing Home only at 9 a.m. on 25th morning.
6) An ordinary consulting physician should not burst a boil in the ear without proper medical surveillance.
7) When there was infection in the ear, my husband should have been sent at once for scanning. Four precious days were lost.
8) The blood count itself should have indicated that there was something amiss. Is it not a doctors responsibility to rule out any number of dangers to the patient? Is this not taking his profession lightly?
9) The doctor in question, Dr.Umesh Maganlal Thakkar, has been quoted as saying that he did not expect such a young man to die of meningitis. He also told my sister-in-law when she spoke to him that he could have caught meningitis in Baroda where meningitis is prevalent. When one makes statement of this kind, it means that he knew something and was negligent, with a chalta hai attitude or deliberately did not do anything, thereby amounting to outright murder of the most macabre and grossest kind.
She has pleaded that she has been left at the age of 35 to take care of two small children, who lost their father for no fault of theirs. She has to play the role of both parents for her children. She is not financially well. Her husbands aged parents are living alone in Bangalore. She has pleaded that her family friends, relatives and acquaintances have been shocked at the cruelty and lack of proper medical care and gross negligence committed by todays doctor, who do not bother to care a bit for human life. She has no answer to give to her children as to how their father was treated by the doctor. So, she demanded Rs.20 Lakhs as damages and she has also prayed that Dr.Umesh Thakkar should not be allowed to practice any more. She has pleaded that she has sought opinion of ACASH (Association for Consumers Action on Safety and Health) on 23/08/1997 and her reliefs are based upon the medical expert opinion given by them. She has enclosed all medical papers she possessed.
O.P. filed written statement and pleaded that he had taken proper care and exhibited diligent skill in dealing with the unfortunate patient. He pleaded that said patient was his patient over a decade and he treated him as indoor patient in Parvish Nursing Home for number of occasions. He was also being treated by Dr.B.R. Agrawal, who is a Psychiatrist. The patient was used to self medication to such an extent that he himself used to get his blood and urine test done. The patient was an alcoholic and he had been treated for his alcohol dependency by him. He was also under treatment in Bangalore in 1996 for Alcohol Withdrawal Therapy. He mentioned that he admitted the patient on three previous occasions i.e. 11/02/1995, 11/06/1995 and 20/12/1995. On 11/06/1995 he had personally gone to the house of the patient with Dr.Agarwal and admitted him in Alcoholic Withdrawal Delirium. He pleaded that allegation of complainant that he had not done diagnosis of her husband properly is baseless, unfounded, defamatory and derogatory. He has mentioned his experience and qualifications and pleaded that complainant/Anuradha Sridhar was mislead and misguided by some vested interest to lodge a false consumer complaint.
O.P./doctor pleaded that for the first time, Subramaniam Sridhar come to his Clinic on 20/02/1997 with complaint of fever with pain in the right ear and pain in the throat, which was of one day duration. There was no past history of earache or discharge from ear. He had come along with blood and urine reports. He saw those reports, examined Mr.Subramaniam Sridhar and his clinical diagnosis was that he was suffering from viral upper respiratory tract infection (URTI) with external otitis (localized) and Eustachian Catarrh of the right ear. There was a minimal redness over postero superior part of the external auditory canal (Cartilagenous part). Systemic examination did not reveal any abnormality. He, therefore, prescribed certain tablets with a view that patient should get relief by the medication to reduce congestion in the throat and Eustachian tube and also to give relief from fever. He also prescribed multivitamin tablets. Theragran-M and asked the patient to take rest. But, instead of taking rest, against the medical advice, patient went to Baroda by air and on 21/02/1997 he was at Baroda. On 22/02/1997 again he saw the patient with complaint of fever with chills, sore throat and pain in the right ear. On local examination of the right ear, it was found that there was small pustule in the external canal. Malarial Parasites were not seen in the blood smear. He therefore advised him some tablets which could be used for malarial treatment. He also prescribed Otek AC Ear drops with a view to ensure that patient gets symptomatic reliefs. Thereafter, again he saw him in the morning of 23/02/1997 at Parvish Nursing Home. His complaint was the same. In order to get relief from his pain in the right ear, he decided to burst pustule in the external auditory canal. He drained out drop of pus and patient appeared to be relieved of pain. He asked him to repeat blood test. On next day i.e. 24/02/1997 at about 8.00 p.m. patient came with blood and urine report. His complaint was the same. He examined him since he was having severe pain in right side of head and right ear. He decided to refer him to Dr.Gaurang B. Dalal. Patient was examined by Dr.Dalal, who prescribed certain medicines. Dr.Dalal advised the patient X-ray Mastoids. He explained to the patient and his father why he was giving particular kind of medication. After giving prescription they went away.
On the same day, at about 10.40 p.m. he received phone call from Mrs.Sridhar that her husband was not feeling well after taking tablet and he had high fever with shivering and he was talking irrelevantly at times. He asked her to give Valium along with Claribid and Ultraflam tablets and to inform Dr.Dalal also. He asked to inform him if there was any further problem. But, there was no request from her to visit at their residence. It was only after 2.30 a.m. he received a phone call from the R.M.O. of Parvish Nursing Home that complainants husband was admitted with restlessness and headache. R.M.O. informed him that neck rigidity and other meningial signs were absent. Patient had demanded Libotryp tablet and swallowed the same at about 2.30 .am. His diagnosis was delirum due to alcohol withdrawal in addition to painful Right Mastoidities. He asked the R.M.O. to give injection Voveran and some other injections. R.M.O. contacted him after one hour and informed him that he had given injection Fortwin and Phenergan to relieve the pain. At about 7.00 a.m. on 25/02/1997 R.M.O. informed him that patient slept well at night. Patient appeared to be restless, possibly due to distended urinary baldder. He saw the patient at 9.00 a.m., the patient was deeply unconscious and hyperventilating, Right pupil was normal and left pupil semi dilated. There was neck rigidity, but there was decerebrate posture on deep painful stimulus. It appears that patient had suddenly deteriorated. So, he immediately started injection Mannitol after urinary catheter was put. He did guarded Lumber Puncher and 0.5 ml. of turbid fluid was sent for urgent pathological testing. Some injections were administered to the patient. As per CSF Laboratory report, patient was having meningitis and possibly ruptured cerebellar abscess in the brain. He told complainant and patients father about seriousness of the condition of the patient and sudden deterioration of his condition. He told them that there was need to transfer him to bigger institution with ICU and MRI facilities. He needed ventilator support. He, therefore, telephoned Nanavati Hospital, Hinduja, Bombay and Jaslok Hospital and tried to get a bed in their ICU. However, there was no vacant bed available in any of these hospitals. Eventurally, he could procure a bed in Bombay Hospital ICU. He spoke with Dr.B.S. Singhal, Hon. Neurologist under whose care patient was admitted at 1.00 p.m. Then, meanwhile the patient was going into the respiratory arrests for a short while. He immediately called Anaesthetist Dr.(Mrs.)Parul Patel, who passed an Endotreacheal tube. The air blast was satisfactory and there was very few secretions in the trachea. Before transfer of the patient, seriousness of the patient was informed by him and Dr.Patel to the complainant. The patient was shifted in the ambulance. He accompanied the patient with all necessary drugs and anaesthetic equipment for ventilation. On the way, patient developed cardiac arrest. He tried to resuscitate the patient with external cardiac massage and intra-cardiac adrenaline. Ventilation was continued in the ambulance with Ambubag. However, patient again went into cardiac arrest and by the time they reached Bombay Hospital, patient was declared dead.
O.P./doctor pleaded that complainant, her father-in-law and her husband were all his patients. When he examined the patient along with Dr.Dalal on 24/02/1997 there was no indication whatsoever that Mr.Sridhar would go in for any major complication like Meningitis, especially in view of the ENT findings of Dr.Dalal. O.P. pleaded that Mr.Sridhar had early Cirrhosis of Liver due to Alcohol dependant in the past. He had also history of psychiatric illness for which he had received treatment in the Bangalore Hospital and was under the treatment of Dr.B.R. Agrawal, Psychiatrist in Mumbai. He had also been treated by Dr.Agrawal at Parvish Nursing Home for Alcoholic Withdrawal Therapy. Mr.Sridhar had Brain Stem Encephalitis because there was stiffness of neck while watching out for infection of a pyogenio meningitis. But, there was no vomiting at any time during his illness. He denied that there was any negligence on his part in treating the patient. He had even gone to the extent accompanying the patient to the Bombay Hospital. He denied that diagnosis and treatment of Mr.Sridhar was done in a casual manner. He denied that he had been negligent and unprofessional as alleged by the complainant in treating Mr.Sridhar. He pleaded that in view of facts and circumstances since there was pain in the right side of the ear, the medication of Febrix Plus and theragran-M were prescribed. Patient had already brought blood reports, certain medicine was prescribed by him. He had put Johnsons ear-bud and pressed it and a drop of pus was drained out. Patient was appearing to have been relieved of the pain. He denied allegations of the complainant that on account of his medical negligence, she lost her husband. He pleaded that at no point of time, he left any stone unturned. He took all the precautions for the welfare of patient. Diagnosis of meningitis could not be arrived at the earlier stage. Before his admission to Parvish Nursing Home, he was treated at Satyam Polyclinic and there was no manifestation of either meningitis or any other differential diagnosis. He had referred Sridhar to Dr.Gaurang Dalal, who was ENT Specialists and he was treated in consultation with Dr.Gaurang Dalal for his pain in ear. He admitted that patient came on 20/02/1997 with a complaint of fever and pain the right ear and he had given appropriate treatment. Small boil in the ear was got burst with the aid of Johnson Ear-bud and pus was drained out. Examination of the patient did not give any indication of severe infection and the patient was already under treatment for upper respiratory tract infection. Dr.Gaurang Dalal was also monitoring the situation of the complainants husband. He pleaded that had he been called by Mrs.Sridhar to her home, he could have rushed to their house for examining Mr.Sridhar. He pleaded that in the Parvish Nursing Home, there were qualified doctors to monitor condition of all indoor patients and he always keep himself informed about conditions of the patients and the treatment to be given to them. Even at 2.30 a.m. he received phone call from his R.M.O. about condition of Mr.Sridhar and he had issued necessary medication. He denied that he had shown any negligence in referring the patient for CT Scan. He pleaded that blood count on 26/02/1997 suggested bacterial infection and therefore, diagnosis was made that there was Acute Otitis Media with Mastoidities and that was confirmed by ENT Surgeon Dr.Gaurang Dalal. Dr.Dalal recommended X-ray of the Mastoids which was to be taken on next day. However, due to condition of the patient, this could not be done. He denied that he had told the complainant that the patient might have not Meningitis at Baroda. He denied that he had exhibited attitude of Chalta Hai as alleged by the complainant. He asserted that he had given full attention to the patient and he had taken advice of Dr.Dalal, ENT Surgeon whenever it was required and death of the patient was misfortune and there was no negligence or deficiency in service in treating said patient. He admitted that depiste best possible treatment given to the patient his life could not be saved because patient was victim of sudden spread of infection in the Meningitis. He denied allegation of complainant that her husband was murdered by doctor. He repudiated all the allegations made by the complainant against him. He denied that complainant is entitled to get compensation of Rs.22 Lakhs for death of her husband. He disputed the report given by AKASH and pleaded that AKASH should disclose the name of doctor who had given expert opinion in favour of the complainant. He, therefore, pleaded that complaint should be dismissed with costs.
We heard submissions of Ms.Archana Sabnis, Advocate h/f.Mr.Shirish Deshpande, Advocate for the complainant and Mr.Raja Thakre, Advocate for the O.P. Following points arise for our determination and our findings thereon are as under :-
Points Findings
1. Whether complainant proves that O.P. has exhibited No medical negligence in treating her husband?
2. What order, if any? Complaint stands dismissed.
REASONS:
At the outset it must be stated that affidavit of expert was not filed when the complaint was filed in the year 1998 by the complainant. At the time of filing of the complaint, complainant had filed one letter issued by AKASH which is a NGO working in Mumbai, who cares for professionalism in medical field. Unfortunately, said opinion given by AKASH is not on file. But, somewhere in 2003 complainant filed affidavit of Shri Pusalkar, who had given opinion on behalf of AKASH, NGO. Other than this affidavit no evidence has been adduced by the complainant. Complainant is not a medical expert though she appears to have studied a lot before filing consumer complaint. Her basic contention was that O.P./Dr.Umesh Thakkar is Physician and Cardiologist and is not an ENT Surgeon. O.P./Physician is the family doctor of the complainant for more than 10 years. According to her, O.P. ought not to have treated her husband/Sridhar for the simple reason that Sridhar was suffering form ENT problem, so he should have referred her husband/Sridhar to ENT Surgeon. But, he had treated himself all though to her husband/S.Sridhar and gave wrong medicine and therefore, according to the complainant, she lost her husband because of negligence of the O.P./doctor. The complainant has alleged medical negligence only on the ground that Dr.Umesh Thakkar primarily treated ENT patient and he had not referred her husband to ENT Surgeon and he continued to treat her husband himself. However, this fact is refused by Dr.Thakkar, who has in his affidavit and in written arguments categorically mentioned that he had treated complainants husband as indoor patient. On number of occasions, patient was also treated by Dr.B.N. Agarwal, who is Psychiatrist for considerable long period. Since Late S.Sridhar was an alcoholic and he was been treated for his alcohol dependence by Dr.Thakkar. He had also taken treatment in Bangalore for Alcohol Withdrawal Therapy. According to Dr.Thakkars affidavit Late Sridhar came to his Clinic for the first time on 20/02/2007 with complaint of fever with pain in right ear and pains in his throat. He had also come with blood and urine reports. He was accustomed to get his GGTP and SGPT tests done from time to time in order to reduce his own anxiety about alcoholic effect on his liver. He had seen the blood report of Late S.Sridhar. He examined the complaint of Sridhar and his clinical diagnosis was that he was suffering from viral upper respiratory tract infection (URTI) with external otitis (localised) and Eustachian Catarrh of the right ear and there was congestion in the throat and the eardrum appeared normal and there was minimal redness over the postero superior part of the external auditory canal (Cartilagenous part). Systemic examination of the patient did not reveal any abnormality. On the basis of this clinical and physical examination he prescribed tablet Febrex Plus (phenyl Propanolamine 25 mg., Paracetamol 500 mg and Chlorpheniraminc 25 mg). These tablets were prescribed with a view that patient could get relief by medication in order to reduce congestion in the throat and Eustachian tube and he would get relief from the fever. He also prescribed multivitamin tablet-Theragran-M and asked the patient to take rest, but instead of taking rest patient against the medical advice, went to Baroda by air on 21/02/1997. He again came to him on 22/02/1997 and complained of fever with chill, sore throat and pain in right ear. He advised tablet Vibazine (100 mg) to arrest malarial infection. He also advised Vibazine which is antibiotic useful in common causative organisms of otitis media which would have also taken care of Furuncle in external canal. He also asked him to take another tablet which he mentioned in written statement. He prescribed Otek AC Ear drops with a view to ensure that patient could get symptomatic relief. Thereafter, again he saw patient in the morning of 23/02/1997, complaint was the same. On local examination he found that Pustule in the ear in external auditory canal was about to burst and in order to relieve from pain he pressed it with Johnsons ear bud and drained out the pus. Patient appeared to be considerably relieved of the pain. He asked the patient to repeat the blood test and come to see him on the following date. On 24/02/1997 Late S.Sridhar came about 8 p.m. in his Consulting Room with blood and urine reports. He examined the patient and did not reveal any abnormality. However, since he had severe pain in the right side of Head and right ear pain, he decided to refer the patient to ENT Surgeon. So, patient was referred to Dr.Gaurang B. Dalal, the ENT Surgeon. Dr.Gaurang Dalal advised the patient to take x-ray of Mastoids. He explained to patients father the treatment allegedly given by Dr.Gaurang Dalal and some drugs prescribed by him. Then patient and his father went home at about 9.15 p.m. At around 10.30 p.m. on the same day, he received a phone call from Mrs.Sridhar who informed that her husband was feeling uneasy and he had high fever and he was talking irrelevantly at times.
Talking irrelevantly and in delirium was the patients habitual symptom since his was the case of alcohol withdrawal dependence symptoms. He asked Mrs.Sridhar/complainant to give Valium tablet with Claribid and Ultraflam tablets and also to inform the condition of the patient to Dr.Dalal. He also informed her that she may contact him again if there was any further problem, but she did not contact. However, at about 2.30 a.m. he received a phone call from Parvesh Nursing Home that Late S.Sridhar had been admitted with restlessness and headache and his pulse rate was 120 per minute, BP 160-180 and he was afebrile, pupils were normal. He appeared to be drowsy and irritable. He had asked RMO whether patient was suffering from any neck rigidity, the RMO informed that that was absent and he had been complaining of vomiting. So, from the symptoms and signs his diagnosis was delirium due to alcohol withdrawal in addition to painful right Mastoiditis. He asked the RMO to give Voveran injection and some other tablets. He continued to monitor the health of S.Sridhar even thereafter. However, in the following morning, patient became serious and his condition deteriorated. He then gave injection Mannitol after putting urinary cathedral. He did lumber puncture and 0.5 ml. of turbid fluid was sent for pathological testing. He received CSF Report on telephone and it was consistent with Meningitis and possibly ruptured cerebellar abscess. He therefore explained the condition of the patient to Mrs.Sridhar and suggested that he should be taken to bigger institute having ICU and MRI facility. He ultimately found that Bombay Hospital was having bed in ICU unit. He spoke with Dr.B.S. Singhal, Neurologist. In the meanwhile, patient was going into respiratory arrest for a short while. He immediately called Dr.Parul Patel, Anesthetist, who passed Endotreachdal tube. Air blast was satisfactory and there were few secretions in the Trachea. Before transfer, seriousness of the patient was informed by him and Dr.Patel to Mrs.Sridhar. Patient was shifted in ambulance which was well equipped with ventilation machine. When the patient developed cardiac arrest, he resuscitated the patient with external cardiac massage and intra-cardiac adrenaline, ventilation was continued with Ambu Bag. However, patient continued to have cardiac arrest and attempts of resuscitation were not successful and by the time they reached the Bombay Hospital, patient was declared dead.
In the Death certificate of S. Sridhar, it was clearly mentioned that cause of death is due to cardiac arrest.
It is questioned by complainant why this O.P. had not referred the patient right from beginning to ENT Surgeon. Patient approached O.P. for the first time on 20/02/1997 and against the medical advice, he had gone to Baroda.
Then, he came back with complaint of pain in right ear. His throat was sore, hence, as per clinical examination Dr.Thakkar started treatment to the patient. When he found that there can be a case of ENT Specialist he referred Sridhar to ENT Surgeon Dr.Gaurang Dalal. So, he did everything as could have been done by a man of ordinary prudence. He did everything as could have been expected of a Physician of his standing. It is not the case of the complainant that he had not referred the patient (S. Sridhar) to ENT Surgeon. In fact when he found that his prescription was not helpful to the patient, he had decided to refer the patient to Dr.Gaurang Dalal, who is ENT Surgeon. Dr.Dalal was treating him till he became very serious and was required to be shifted to hospital having ICU facility. In the ambulance Dr.Thakkar himself accompanied the patient. The ambulance was well equipped with ventilation machine, but before he could be admitted in the Bombay Hospital, patient died because of cardiac arrest.
Dr.Pusalkars affidavit has been heavily relied upon by the complainant. Dr.Pusalkars affidavit mentioned that when there was possibility of more than one suspected diagnosis, doctor must rule out the possibility of an ailment with lesser risk. According to Dr.Pusalkar in the instant case, two possibilities existed (i.e. delirium due to alcoholic withdrawal and otitis media/meningitis) then otitis media/meningitis being greater evil should have been ruled out first. Dr.Pusalkar is finding fault with O.P./Dr.Thakkar only on the ground that Dr.Thakkar had not tried to rule out possibility of otitis media/meningitis in the first instance, but he continued to give tablets for the first possibility of delirium due to alcoholic withdrawal and not ruled out other possibility which was greater evil according to Dr.Pushalkar. It is also opined by Dr.Pushalkar that delirium due to alcoholic withdrawal was to be handled by a Psychiatrist and similarly, if there is suspected otitis media/meningitis, it was the ENT Specialist who should have handled Sridhars case. But, the M.D. (Cardiologist) as Dr.Thakkar was, was not qualified to handle such a patient. So, it is the opinion of Dr.Pushalkar that in either case Dr.Thakkar ought not to have handled Mr.Sridhar and should have referred to Psychiatrist and ENT Specialist.
Assuming for a moment that the opinion given by Dr.Pushalkar is true and correct, then we fail to understand how he can allege that Dr.Thakkar was guilty of medical negligence when Dr.Thakkar clearly referred the patient to Dr.Gaurang Dalal on 24/02/1997 itself. So, at the first available opportunity in our opinion O.P./Dr.Umesh Thakkar had referred to the patient to Dr.Gaurang Dalal, ENT Specialist since there was severe pain in the right side of the head and right ear pain. ENT Surgeon was sitting in the very said Polyclinic along with Dr.Thakkar and then further treatment was continued under the guidance of Dr.Gaurang Dalal. But, it appears that on the very same night, patient developed deterioration in health and despite treatment given, patients health could not be improved and ultimately, Dr.Thakkar decided to shift the patient to Bombay Hospital. He contacted Neurosurgeon, arranged for bed in Bombay Hospital. But, before, he could be admitted in the Bombay Hospital, patient breathed his last at about 2.45 a.m. on 24/02/1997 itself due to Acute Pyogenis Meningitis with Brain Stem Encephalitis and Acute Right Otitis Media.
Death of patient by cardiac arrest can occur to any one. Death by cardiac arrest is a sudden death and it cannot be pre-judged even by the expert. Cardiac arrest can happen on operation table also and we have come across number of cases of this nature. So, simply because patient died due to cardiac arrest on 24/02/1997 that itself does not mean that treatment being given or followed by Dr.Thakkar was in any way deficient or negligent looking to the standard protocol followed by Dr.Thakkar. It is also pertinent to note that O.P./Dr.Thakkar has filed his own affidavit and also affidavit of expert in support of his case.
Dr.Arun B. Shah, who is Head of Department of Neurology at B.Y.L. Nair Hospital and T.N. Medical College has filed affidavit on behalf of O.P. who on oath stated that he had seen the papers of the patient S.Sridhar. He had also read the complaint filed before the State Commission and explanation given by Dr.Thakkar in the written statement and on going through all the papers, he observed that differential diagnosis of patient S. Sridhar on admission to the Hospital was narrowed down to :- (i) Delirium due to alcohol withdrawal with mastoiditis (ii) Delirium due to CNS infection such as Pyogenic Meningitis and/or cerebral abscess. Dr.Shah further opined that in view of past history of the patient, known well to Dr.Thakkar, it appeared reasonable to make a provisional diagnosis of clause (i) that Delirium due to alcohol withdrawal with mastoiditis and investigated to rule out second possibility at the earliest. So, this can be considered as a standard practice to be followed for carrying out investigation either to rule out or confirming the provisional diagnosis. So, according to Dr.Shah treatment given by Dr.Thakkar to S. Sridhar was reasonable and proper. Likewise Dr.Thakkar has also filed affidavit of Dr.Sudhakar B. Ogale, who is Professor and Head of the Department of ENT in K.E.M. Hospital and G.S. Medical College. In his affidavit he has stated on oath that he had seen the papers in respect of patient S. Sridhar. He had also read the complaint and written version filed by O.P. and on going through the papers, he opined that Pyogenic Meningitis following Otitis Media and Mastoiditis is a known complication. Bain Abscess secondary to Otitis Media developed in 0.5% in acute cases. He however testified that it was very clear that tablet Doxycycline was prescribed by Dr.Thakkar in view of past history of the patient. It was correct, adequate and proper treatment. The patient was a known alcoholic and he had also undergone Psychiatric treatment for which he has already taking drugs. There were no signs or symptoms of vomiting to suspect meningitis and therefore, patient was rightly given tablet Doxycycline and Clarithromycin and analgesics as prescribed by the ENT Surgeon. It was effective treatment in the case of Acute Otitis Media with Mastoiditis and patient had been attended to efficiently as guided by Dr.Thakkar over phone. Since there was no sign or symptom for establishing meningitis, the attending doctor had rightly continued the same treatment. This doctor opined that in view of these circumstances, there has been no want of care or skill on the part of attending doctor or Dr.Thakkar, especially in view of the fact that the patient was also been examined by ENT Specialist and had not been diagnosed as suffering from meningitis. These two doctors, who were Professors in the leading Medical Colleges of Mumbai asserted that treatment given to deceased S. Sridhar by Dr. Thakkar was standard one and there was no want of skill or want of care on the part of Dr.Thakkar in treating S. Sridhar till his ultimate demise on 25/02/1997. Thus, acting upon the affidavits of two experts filed by Dr.Thakkar and discarding the affidavit given by Dr.Pusalkar on behalf of complainant, we hold that there has been no negligence of any kind or any deficiency of service of any kind on the part of Dr.Thakkar in treating husband of the complainant for the various ailment he was then suffering from. Dr.Thakkar did his best to give proper treatment. He had even referred the patient to Dr.Gaurang Dalal, who was ENT Surgeon and treatment was continued under the guidance of Dr.Dalal and when S.Sridhar became restless and serious, Dr.Thakkar spoke with Neurologist of Bombay Hospital, asked him to make room for his admission in Bombay Hospital, told him as to what was the ailment S. Sridhar was suffering from and accompanied the patient to Bombay Hospital in the ambulance which was fully equipped with ventilator machine and other equipments. But, ultimately at the time of admission in Bombay Hospital, patient was declared dead.
Looking to these facts and circumstances, we are of the view that complainant has failed to prove that there was any medical negligence on the part of Dr.Thakkar in treating her husband and therefore, we have no option but to hold that Dr.Thakkar was not guilty of medical negligence as alleged by the complainant. In the circumstances, we are finding that complaint is devoid of any merits. Hence, we pass the following order :-
-: ORDER :-
1. Complaint is dismissed.
2. No order as to costs.
3. Copies of the order be furnished to the parties free of costs.
(S.P. Lale) (P.N. Kashalkar) Member Presiding Judicial Member