National Consumer Disputes Redressal
Dr.V.K.Ghodekar (M.B.B.S.) vs Smt. Sumitra Pralhad Korgaonkar on 22 May, 2008
NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 1727 OF 2002 (From the order dated 1.7.2002 in F.A.No.76/2000 of the State Commission, Goa) Dr.V.K.Ghodekar (M.B.B.S.) Petitioner Versus Smt. Sumitra Pralhad Korgaonkar Respondent BEFORE: HONBLE MR. JUSTICE M.B. SHAH, PRESIDENT HONBLE MRS. RAJYALAKSMI RAO, MEMBER HONBLE DR. P.D. SHENOY, MEMBER For the Petitioner : Mr. M.N. Krishnamani, Sr. Adv., With Ms. A. Subhashini & Mr.A.V.Rangam, Advocates For the Respondent : Dr. Sanjay P. Korgaonkar, Auth.Rep. 22-5-2008 O R D E R
MRS. RAJYALAKSHMI RAO, MEMBER The questions which require consideration in this revision petition are:
(a) Whether a medical practioner before prescribing a drug, which has side effects, should be careful or not in informing the patient about its side effects such as hypoglycemia etc.?
(b) Whether, a doctor should give treatment for diabetes to a person who is alcoholic, straightway on the basis of urine test report, without confirming by proper pathological test that the patient is suffering from diabetes and thereafter without informing the patient that the medicine should be taken before food and alcohol should be avoided?
In our view, it is the duty of the doctor, before prescribing diabetic drug, to inform the patient about the side effects of a drug, particularly to an alcoholic person and he should be informed that alcohol may increase sugar level and that diabetic drug should be taken before food.
If is not done it will be a deficiency in service.
This Revision Petition arises from the order dt.1-7-2002 passed by the State Consumer Disputes Redressal Commission, Goa, in Appeal No.76 of 2000, reversing the order dt.22-2-2000 of the District Forum, Panaji in Complaint No.310 of 1993.
The facts of the case are as follows :
The complainant Smt. Sumitra Pralhad Korgaonkar filed a petition before the District Forum stating that her husband Pralhad Korgaonkar, aged about 45 years was taken to the opposite party Dr. V.K.Ghodekar, Medical Practitioner at village Aldona on 23-2-1993, as he was having chronic cough and cold. Dr. V.K.Ghodekar, the opposite party, gave some medicines and asked him to come back on 26th February, 1993 with a sample of urine for test. Accordingly on 26-2-93, Shri Korgaonkar, presented himself before the opposite party with the urine sample. The opposite party who tested the urine mentioned that the urine sample showed sugar, which is indicative of diabetes and prescribed one tablet of 5 mg. of Euglucon per day for five days.
The Complainant stated that after taking Euglucon tablet, for 3 days, Shri Korgaonkar, in the early morning hours of 3-3-1993 at about 2.00 A.M., began sweating very much and had convulsions and became unconscious. He had to be rushed to the government hospital at Mapusa at 4.00 A.M., on 3rd March,1993. At the hospital, soon after admission, he went into coma for about 4 days and thereafter recovered consciousness, but remained in the hospital for 40 days and was discharged on 10th April, 1993. He was advised to take the treatment at home. He was again admitted in the hospital on 22-5-1993 for a few days. However, on 5-8-1993, Shri Korgaonkar passed away.
The complainant Sumitra Korgaonkar, who is the wife of the deceased Korgaonkar, alleged that the opposite party prescribed the tablet Euglucon a specific drug for diabetes without ascertaining properly whether the patient was infact suffering from diabetes. Medical literature was produced to show that Euglucon is a very sensitive drug and needs to be administered with care and the dosage is to be regulated carefully depending on the level of blood sugar. It is alleged that Shri Korgaonkar went into coma due to hypoglycemia and that subsequent treatment in the government hospital did not really help him to recover and that his death is directly attributable to rash administration of Euglucon tablets by the opposite party.
The District forum which heard the matter dismissed the complaint on the ground that no negligence has been proved. In Appeal, however, the decision was reversed holding that ;
(a) In the first instance the opposite party did not even ascertain whether the patient was suffering from diabetes at all ;
(b) Without so ascertaining, a specific and very sensitive anti-diabetic drug, dosage of which has to be regulated with care, has been administered ;
(c) The tablets were prescribed in a routine manner without advising the patient who is an alcoholic that he should not consume alcohol and that the drug should be taken only after the food ;
(d) That the patient developed Coma because of the adverse effect of Euglucon.
(e) The opposite party was directed to pay the complainant an amount of Rs.1,09,000/- alongwith interest at 18% and he was also to bear a cost of Rs.5,000/-.
The present appeal is filed by the doctor against the said order.
We heard both the parties and carefully perused the evidence on record. The arguments of the petitioner i.e., opposite party are: (a) that testing of urine sugar is one of the first steps used by general practitioners like him in detecting diabetes; (b) that sugar in the urine indicates that the patient had diabetes; (c) that the dosage of Euglucon prescribed was the minimum; (d) that no evidence has been produced as to when and how the deceased consumed the tablets of Euglucon; (e) that there is no evidence produced to link the development of Coma on 3-3-1993 with the prescription of Euglucon given on 26th Feb 1993; (f) that the patient in fact never came back to the opposite party after taking prescription on 26-2-1993; (g) that no medical record of the Government Hospital, Mapusa was produced to show as to what had transpired in the hospital ; (h) that one of the random blood tests at the Govt. Hospital on 3-3-1993 showed that blood sugar as 185 mg confirms that the patient is a diabetic; (i) that the test which took-place in August-1993 can be of no stretch of imagination be said to have been caused by consumption of three Euglucon tablets of 5 mg each in February, 1993; (j) and that the decision of the District Forum was correct; and urged that the order of the State Commission should be set aside.
The petitioners son who is himself a doctor argued the case for the respondent i.e. for Smt. Sumitra Pralhad Korgaonkar. He submitted ; (i) that for testing whether a person is diabetic or not, testing urine for the same is not a definite test to establish diabetes; (ii) that the urine test can be positive for sugar under various other conditions including alcoholism; (iii) that the opposite party, the doctor, knew that late Shri Korgaonkar was an alcoholic and urine test can be false positive; (iv) that he was not suffering from any serious disease other than chronic cough and cold when he went to the doctor;
(v) that there was no reason for him to go into a Coma soon within 4 to 5 days after seeing the petitioner doctor; (vi) and that the development of Coma can only be attributed to the consumption of tablets prescribed by the petitioner doctor.
It is also argued that while unfortunately no record of the government hospital, Mapusa, could be produced because they were inadvertently destroyed or misplaced by the hospital authorities, evidence of the attending doctors who also submitted themselves to cross-examination is very much on record and it can be relied upon.
We heard both the parties at length and after careful consideration of evidence on record we are of the opinion that the petitioner (the opposite party) was totally negligent in discharge of his duties and that there is a clear deficiency in service provided by him for the following reasons :
The first question that arises is as to why the petitioner doctor (opposite party) wanted to test the urine of late Korgaonkar when he was brought in with the complaint of chronic cough and cold. The petitioner himself answered this by saying that Korgaonkar was smelling alcohol and was in a drunken state and he had suspected him to be an alcoholic. He argued that this is what prompted him to ask the patient to bring his urine for test after four days for possible diabetes.
The medical literature produced on record shows that Euglucon is a drug belonging to Sulfonyl Ureas. This is a specific anti-diabetic drug, which is required to be administered after testing blood sugar levels. As a matter of fact, when diet, exercise and weight reduction do not lower the blood sugar, then the patient is put on drug therapy, with drugs like Euglucon and even then the dosage needs to be adjusted periodically depending on the blood sugar levels. The literature further shows that Severe Hypoglycemia(lowering blood sugar levels) can be induced by Sulfonyl Ureas. These drugs increase release of insulin. Therefore, these drugs like Euglucon are required to be administered immediately after intake of food. Literature further shows that intolerance of alcohol may occur in patient treated with Sulfonyl Ureas. Therefore the patients are strictly advised to avoid alcohol while taking the drug. We find that none of the precautions were given to the patient and the opposite party merely prescribed Euglucon 5 Mg. for five days.
Secondly, the record of admission of the patient to the Asilo Government Hospital on 3-3-1993 clearly shows that he was admitted at 4.00 A.M. on complaint of convulsions. The patients relatives told the attending doctor, Dr. S.S. Govekar, that the patient was not talking since 2.00 A.M., that he had convulsions and frothing at the mouth, and that he had a similar convulsions at 8.00 P.M. on the previous night. They told the doctor that the patient had taken one tablet of 5 mg. Euglucon for the previous 4 days. Dr. Govekar confirmed these facts in his cross-examination, and stated that his diagnosis was that of Hypoglycemia (fall in blood sugar level) due to consumption of Euglucon, with chronic bronchitis. Dr. Govekar stated that he had taken a blood sample to find out random blood sugar level, and thereafter administered 2 ampules of 24% glucose to restore the blood sugar level. This record at the time of admission in the hospital is a contemporaneous record and has to be relied upon.
It is clear from the above that in the very first instance when the patient was brought to the hospital in a comatose condition, the attending doctor felt that it is a case of Hypoglycemia resulting from the administration of 4 tablets of Euglucon over the past 4 days. This tentative diagnosis has been confirmed by the very first blood sugar test taken on 3-3-1993 soon after admission of the patient in the Asilo hospital, which showed the Random blood sugar at less than 50 mg. It is clear that the culprit is Euglucon administered to a non-diabetic patient.
The third issue to be considered is whether the opposite party was right in coming to the conclusion that the patient was having diabetes on the basis of urine test conducted by him. The State Commission in its speaking order quoted extensively from medical literature to show that the opposite party was wrong to come to such conclusion.
Dr. Stephen Fajan and Dr. Robert Williams, MD, Professor of medicine, University of Washington, in their book Methods and Criteria for Diagnosis of Diabetes Mellitus stated as follows:
The presence of Glycosuria never establishes the diagnosis, and blood sugar determination must be made to confirm or eleminate the diagnosis of diabetes. Renal and alimentary Glycosuria must be differentiated from diabetic Glycosuria as discussed later. Other Meliturias and non sugar reducing substances in urine which may give false positive reactions for glucose also must be considered.
In Davidsons Principle and Practice of Medicine, 15th Edition, 1987, on page 467, it is stated ;
Glycosuria. the most serious disadvantage in the use of urine test diagnostically arises from individual variations in renal threshold, so that on the one hand some undoubtedly diabetic people have a negative urine test for glucose due to raised renal threshold, and on the other those with a low renal threshold give a false positive test. In order to distinguish cases of this type from patients with mild diabetes, suitable tests of carbohydrate tolerance is required.
A perusal of the above authorities on the subject show a unanimity of opinion that blood sugar estimation and glucose tolerance test are mandatory before confirming diagnosis. Further, the opposite party himself in his affidavit-in-reply has admitted, the patient was suffering from chronic alcoholism and all types of complications. He further admitted in his cross examination that, sometimes the urine shows positive sugar test even though there is no sugar. However, it is in certain cases like pregnancy and chronic alcoholism etc. Both the statements clearly show that the opposite party is aware that the patient being alcoholic, urine test could show a false positive. The opposite party clearly ignored standard medical practice and was further negligent in discharge of his duty to the patient.
The last issue to be considered is whether administration of the prescribed dosage of Euglucon can cause the damage that the patient suffered in this case.
Dr. Dulari Pandodkar, who attended to the patient in the Asilo Hospital has stated in her examination in chief; at the time of discharge of the patient he had behaved abnormalities due to prior irreversible, neurological damage suffered by the patient following drug induced hypoglycemic coma; In cross; I say that one tablet of Euglucon per day given to a normal person can cause hypoglycemia causing lack of supply of glucose to the brain resulting in irreversible damage to the brain. This can also occur in patients taking normal diet.
Similarly, Dr. M.R.Pendekar, Senior Physician at the Asilo Hospital issued a certificate dt.25-8-1993 stating that Pralhad was diagnosed as a case of chronic alcoholism with drug induced Euglucon hypoglycemic coma with irreversible neurological damage. This opinion remained unshaken and unrebutted in cross-examination. The deposition of the two doctors as well as the initial diagnosis of Hypoglycemia by Dr. Govekar, discloses a unanimous opinion that the patients hypoglycemic coma was induced by the drug Euglucon.
In view of the findings we fully endorse the well-reasoned order of the State Commission and dismiss the revision petition. There shall be no order as to costs.
..J ( M.B. SHAH) PRESIDENT ..
(RAJYALAKSHMI RAO) MEMBER .
(P.D. SHENOY) MEMBER rk.