National Consumer Disputes Redressal
Prem Lata & 2 Ors. vs Dr. Arun Kumar Sinha & 2 Ors. on 9 September, 2016
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI FIRST APPEAL NO. 552 OF 2015 (Against the Order dated 09/06/2015 in Complaint No. 03/2011 of the State Commission Bihar) 1. PREM LATA & 2 ORS. W/O. LATE SH. RAKESH BHARTI, R/O. VILLAGE KORIYAWANGARH, P.O. USMAN CHAK, MASAURHI, PATNA, BIHAR 2. ADITI BHARTI (MINOR) THROUGH HER MOTHER/NATURAL GUARDIAN, SMT. PREM LATA, R/O. VILLAGE KORIYAWANGARH, P.O. USMAN CHAK, MASAURHI, PATNA, BIHAR 3. DMT. DEOMANTI DEVI W/O. SH. RAMA KANT RANJAN KISHORE, R/O. VILLAGE KORIYAWANGARH, P.O. USMAN CHAK, MASAURHI, PATNA, BIHAR ...........Appellant(s) Versus 1. DR. ARUN KUMAR SINHA & 2 ORS. DIRECTOR/OWNER OF RAJESHWAR HOSPITAL, R/O. A/130, BHAGAT NIWAS, HOUSING COLONY ROAD, KANKARBAGH, NEAR PANCH SHIV MANDIR, MAIN ROAD, KANKARBAGH, P.S.: KANKARBAGH, DISTRICT-PATNA, BIHAR, 2. DR. VIJAY PRAKASH R/O. BIHAR INSTITUTE OF GASTROENTERLOGY, YOGIPUR CHOWK, KANKARBAGH, P.S.:- KANKARBAGH, DISTRICT-PATNA, BIHAR 3. DR. SANJEEV KUMAR THAKUR, R/O. BIHAR INSTITUTE OF GASTROENTERLOGY, YOGIPUR CHOWK, KANKARBAGH, P.S.:- KANKARBAGH, DISTRICT-PATNA, BIHAR ...........Respondent(s)
BEFORE: HON'BLE MR. JUSTICE AJIT BHARIHOKE,PRESIDING MEMBER HON'BLE DR. S.M. KANTIKAR,MEMBER For the Appellant : Mr. Sunil Kumar Verma, Advocate For the Respondent : For the respondent No.1 : Mr. Anoop K. Kaushal, Advocate For the Respondents 2&3 : Mr. Jayant K. Mehta, Advocate with Mr. Sukant Vikram, Advocate Dated : 09 Sep 2016 ORDER DR. S. M. KANTIKAR, MEMBER
1. Brief facts relevant to decide this appeal are that the appellant/complainant Prem Lata's husband, Shri Rakesh Bharti (herein referred as 'the patient'), was given wrong medication i.e. Proton Pump Inhibitors (PPI group of medicines), by Dr. Arun Kumar Sinha, OP 1, Dr. Vijay Prakash, OP 2 and Dr. Sanjeev Kumar Thakur, OP 3, which led to drug induced Stevens - Johnson Syndrome (SJS) causing death by Toxic Epidermal Necrolysis (TEN). The chronology of events that, the patient was suffering from cold, headache and mild fever since 27.7.2010 till 2.8.2010. He took treatment from different doctors and lastly, as per advise of Dr. Thakur R.B. P.N. Singh, he was hospitalized at Rajeshwar Hospital, Patna on 2.8.2010 under care of Dr. Arun Kumar Sinha, OP 1. He remained indoor patient from 2.8.2010 to 9.8.2010. At the time of discharge, OP 1 prescribed RABETOSS -D, a medicine of PPI Group, which caused severe reaction to the patient. It was prescribed without proper care. On 10.8.2010, the patient approached OP 1 again but, there was no response to his treatment, then on 14.8.2010 he approached OP 2/Dr. Vijay Prakash at Bihar Institute of Gastroenterology, who advised to stop previous medicines. He remained under treatment of OP 2 and another visiting doctor, Dr. S. K. Thakur, OP 3. On 28.08.2010, OP 3/Dr. S. K. Thakur prescribed medicine Panto D again i.e. the medicine of same PPI group which caused further reaction. Therefore, it was the negligence as knowingly, the OPs 1 to 3 prescribed PPI group medicines. On 29.08.2010, the patient was discharged from Bihar Institute of Gastroenterology and advised to consult Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow (SGPGI, Lucknow) for further management of Steven's Johnson Syndrome.
2. Thereafter, the patient took treatment in SGPGI, Lucknow wherein the patient was diagnosed as Steven's Johnson Syndrome and advised for hospitalization but due to paucity of bed, the patient could not get admitted at SGPGI, Lucknow. Therefore, he was again admitted in Bihar Institute of Gastroenterology under care of OP 2 on 31.8.2010. During the treatment, OP 2 again prescribed Pantodec 40 upto 3.9.2010, which caused adverse reaction. The patient developed fresh erythematous spots on other parts of the body. On 3.9.2010, Dr.Sudhanshu Singh stopped the medicine Pantodec-40. The redness went on increasing and exfoliative lesion started developing from 6.9.2010. Thereafter, Dr. Vijay Prakash/OP1 and OP 3/Dr. S. K. Thakur stopped entertaining the patient and pressurized him to vacate the bed immediately. In the meanwhile, from 7.9.2010 to 13.9.2010 the patient was not attended by any doctor, but the compounder and nursing staff of the hospital were looking after the patient. Thereafter, the patient was taken to Shri Ram Hospital Patna on 13.9.2010 where he survived till 20.9.2010. Therefore the complainant alleged that her husband/patient died ultimately due to negligence in the treatment of opposite parties/doctors, not given proper medicines but the medicines which got reaction were administered. The complainant incurred lot of expenses and suffered mental agony. Therefore, the complainant filed a complaint before Bihar State Consumer Disputes Redressal Commission, Patna and prayed for compensation of Rs. 50 lakhs against the opposite parties.
3. The State Commission after hearing the parties dismissed the complaint. Therefore, aggrieved by the impugned order of the State Commission, this first appeal was filed by the complainant under Section 19 of the Consumer Protection Act, 1986.
4. We have heard learned counsel for both the parties. The counsel for the complainants argued that the death of patient was due to gross negligence. Even though knowing PPI drugs sensitivity to the patient, OPs 2 and 3 repeatedly administered PPI Group drugs. Therefore, the patient suffered SJS and ultimately, died due to its complications. The rival arguments on behalf of counsel for the OPs that the complainants failed to prove their case. There is no expert opinion to show that the drugs were administered negligently. Counsel brought our attention to the medical records that at the first instance, on 27.7.2010 the patient consulted Dr. Shailendra Kumar, a physician. Thereafter, on 29.7.2010, the patient, suffered jaundice, consulted one Dr. Bir Prakash Jaiswal, a Pediatrician. He advised complete bed rest and soft diet. Thereafter, on 2.8.2010, the patient approached Dr. Thakur R.B.P.N. Singh. He also recorded that the patient had jaundice, itching over body and fever. On examination, there were rashes all over the body. Then, the patient was referred to OP/Dr. Arun Kumar Sinha on 10.8.2010 wherein he advised RABITOS-D. The clinical notes revealed that there was no history of known allergy. Dr. V. P. Singh took dermatological consultation and started IV fluids and proper antibiotics alongwith steroids and local creams. The patient was followed up daily in Bihar Institute of Gastroenterology from 18.8.2010 to 29.8.2010. He was monitored with regular investigations like Liver Function Test. In the course of treatment, the patient developed a erythematous rashes over the back. The discharge summary clearly mentioned about the treatment aspects, which is reproduced as below:
" Hospital course managed with:-
(1) Inj. Dexona Avil, Kenacort, Pantodac, Albumin, Vit-K (1 bottle) (2) Inj. Mikacin, Augmentin (3) Tab. Ursocol Lumetherfort DT, Liverubin, Omnacortil, Ridar, Microcef DT, Biosuganril (4) Cream - Halox, Hidrate, Elovera, Soframycine.
(5) Cap. Z & B. (6) Eydrop - Betnesol, Neosperine, Nebrain (e/o) DM, Systan Patanol (7) syp. Polycrut fort gel.
(8) Nadexin Ointment (9) IVF & other supportive."
5. Thereafter, from 31.08.2010, the patient was shifted to Sanjay Gandhi Post Graduate Institute of Medical Sciences (herein after referred as 'SGPGI'), Lucknow. The medical record of SGPGI revealed, the patient developed Stevens - Johnson Syndrome after administration of Azithromycin on 27.7.2010 and thereafter since 29.7.2010, he developed jaundice. Therefore, the patient at SGPGI advised admission of the patient but due to non-availability of the beds, the patient was again admitted back to Bihar Institute of Gastroenterology on 1.9.2010. Thereafter, he was treated symptomatically. Further, the patient developed fresh erythematous rashes. OP-2 took opinion from Dr. Sudhanshu Singh. In this context the medical record and daily nursing notes of Bihar Institute of Gastroenterology clearly show that the patient was regularly monitored during the hospitalization. The patient was suffering from exfoliative dermatis i.e. Steven Johnson's Syndrome. It cannot be ascertained the cause by which medicine, the patient suffered Steven Johnson Syndrome but there is clear history that prior to approaching OP 1 and 3, patient took treatment from Dr. Shailendra Kumar and Dr. Bir Prakash Jaiswal. Thereafter, patient was suffering from severe jaundice. Therefore, we don't find any role of OPs 1 to 3 in the causation of jaundice due to drug reaction. From the medical record, it is clear that the OPs treated the patient as per prescribed guidelines and we do not find any deviation or lapses in the treatment. The OPs investigated the patient properly and thereafter, administered the treatment of specific antibiotics, anti-histaminic and other drugs. We took references from Medical textbooks from Harrison's Internal Medicine (19th edition), Pathology of skin and several other medical articles. It is noted that Steven Johnson syndrome is a dreaded and fatal disease.
The complainant relied upon the judgment in the case of V. Krishnakumar vs. State of Tamil Nadu & Ors. Civil appeal No. 8065 of 2009 decided on 1.7.2015, whereas the counsel for OP produced citations namely, C. P. Sreekumar (Dr.) vs. S. Ramanujam (2009) 7 SCC 130, Prayag Hospital & Research Center Pvt. Ltd. & Anr. Vs. Vijay Pal, revision petition No. 293 of 2012 decided on 8.2.2016, Jacob Mathew vs. State of Punjab & another (2005) 6 SCC 1.
6. Learned counsel for the opposite party relied upon the Review Article 'Toxic Epidermal Necrolysis and Stevens Johnson Syndrome : Our current understanding Allergology International 2006;55:9-16 in which it is stated that 'Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse drug reactions characterized by a low incidence but high mortality. The incidence of SJS is approximately 6 cases per million persons per year, and that of TEN is approximately 2 cases per million persons per year'. 'Optimal medical management of SJS and TEN requires early diagnosis, immediate discontinuation of the causative drug(s), supportive care, and specific therapy. Attempts have been made to decrease mortality in TEN patients essentially through improved supportive care.'
7. In the instant case, the patient approached OPs after initial treatment taken from Dr. Shailendra Kumar. The duty of OPs was to treat the complications which were developed after previous treatment. On persual of medical record from OP hospital, the SGPGI we do not find any deficiecny in tratment aspect. It was the standrad care in the cases of SJS. The present complaint is not maintainable as the doctors whose medicines were taken between 27.07.2010 - 09.08.2010 by the complainant prior to consulting the OPs are not made a party in the present proceedings. The medical literature on SJS/TEN suggest that the same are caused usually by antibiotics or anti-inflammatory medicines rather than PPI group of medicines.
8. Our this view dovetails with the case Laxman Balkrishna Joshi (Dr.) Vs. Dr. Triambak Bapu Godbole, AIR 1969 SC 128, the Hon'ble Supreme Court held that a doctor when consulted by a patient owes him certain duties. It has held as under:
A person, who holds himself out ready to give medical advice and treatment, impliedly undertakes that he is possessed of skill and knowledge for the Purpose. Such a person when consulted by a patient owes certain duties, namely, a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to give, and a duty of care in the administration of that treatment.
9. The medical professionals are duty bound to protect life. Generally, the obligation of a medical practitioner emerges from the fact that he does something to a human being which is likely to cause physical harm unless it is done with proper care and skill. Negligence means and includes careless state of mind which may amount to reckless or indifference, careless conduct without reference to any duty to take care and breach of legal duty to take care. Negligence amounts to tort: (a) when there is a legal duty to exercise due care; (b) breach of the duty; and (c) available consequential damages.
10. Therefore, on the basis of the foregoing discussion, in the instant case the OPs 1 to 3 have treated the patient having complications like SJS/TEN. OPs have exercised their duty of care as per the standard of medical practice. We do not find any breach of duty and the consequential damage occurred in the patient due to the treatment or any deficiency of OPs 1 to 3. Therefore, we do not find any need to interfere with the well-reasoned order of the State Commission. Hence, the first appeal is dismissed.
......................J AJIT BHARIHOKE PRESIDING MEMBER ...................... DR. S.M. KANTIKAR MEMBER