State Consumer Disputes Redressal Commission
Doctor N.Narayana,Naveena Hospital, ... vs Y.Srinivas Rao,Karimnagar District. on 26 April, 2010
BEFORE THE A BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION : HYDERABAD F.A.No.274/2007 against C.D.No.240/2003, Dist. Forum, Karimnagar Between: Doctor N.Narayana, Naveena Hospital, Santhosh Nagar, Jagitial, Karimnagar District. Appellant/ Opp.party And Y.Srinivas Rao, S/o.Rama Rao, age 36 years, R/o.Jagitial, Karimnagar District. Respondent/ Complainant Counsel for the Appellant : M/s.P.Raja Sripathi Rao Counsel for the Respondent : CORAM:HONBLE JUSTICE SRI D.APPA RAO, PRESIDENT, AND SMT. M.SHREESHA, HONBLE MEMBER
MONDAY, THE TWENTY SIXTH DAY OF APRIL, TWO THOUSAND TEN.
Oral Order :(Per Smt.M.Shreesha, Honble Member).
**** Aggrieved by the order in C.D.No.240/2003 on the file of District Forum , Karimnagar, the opposite party preferred this appeal.
The brief facts as set out in the complaint are that the complainant suffered from fever and headache and went to the opposite party hospital on 21.2.2002 and the opposite party prescribed some medicines because of which he developed number of patches on his body and he visited opposite party again on 25.2.2002 but the opposite party did not prescribe any anti-allergy medicines and the infection spread all over his body. Once again the complainant visited the opposite party hospital on 27.2.2002 at 11.00 a.m. with a swollen body with acute black colour and breathing difficulty. The complainant was shifted to Karimnagar and consulted Dr.A.Laxminarayana at 4 p.m. who stated that the condition of the complainant is critical and was advised tobe shifted to Yashoda Hospital, Hyderabad on 28.2.2002 at 6 p.m. where he was treated as inpatient till 21.3.2002. The specialist doctor who treated the complainant submitted that the drug allergy developed into gangrene of both feet and he was once again admitted in Yashoda Hospital and both his feet were amputated and he was discharged on 15.5.2002 and from 15.5.2002 to 2.7.2002 he was treated for dressing in Aparna Hospital, Karimnagar as per the advise of the specialist doctors at Yashoda Hospital. On 3.7.2002 he was once again admitted in Yashoda Hospital where skin grafting was done on 10.7.2002 and he was discharged from the hospital on 16.7.2002 and is still undertaking treatment.
The complainant submits that he is not a diabetic and had the opposite party given proper treatment for drug allergy on 25.2.2002 he would not have lost both feet and would not have spent Rs.3,50,000/- towards medicines and treatment and become handicapped all his life. He got issued a legal notice on 18.9.2002 for which he received a reply on 3.10.2002 wherein the opposite party admitted that he treated the patient but denied any medical negligence. Hence the complaint seeking direction to the opposite party to pay Rs.3,50,000/- towards medical expenses , Rs.2,50,000/- towards the permanent disability , mental agony and damage and Rs.1000/- towards costs.
Opposite party filed counter stating that the complainant visited the opposite party on 21.2.2002 complaining of fever and headache for one week and opposite party checked his B.P. and pulse rate and recorded the same as 120/70 and 80 respectively and prescribed medicines Tablets Codroxil, Medomol , Bonacid forte and Denim and Serum Forte. These drugs have no side effects and are commonly used drugs and were prescribed by the opposite party on diagnosing that the complainant was suffering from Viral Fever. The drugs prescribed are for the following causes:
Sl.No. Name of the drug Nature and Cure
1.
Tablet Codroxil Antibiotic
2. Tab.
Medomol Paracetamol for Fever and Anti-inflammatory
3. Tab Bonacid Forte to control Eenofilia
4. Tab Denim Nimuslide/Head Ache
5. Tab Serbin Forte B.Complex for strength Once again the complainant visited the opposite party hospital on 25.2.2002 complainant allergy all over the body and the opposite party prescribed the following medicines :
Sl.No. Name of the Drug Nature and Cure
1. Roxitab For allergy/rash
2.
Tab. Medomol Paracetamol for fever and Anti-inflammatory
3. Vomitab Anti Emetic Opposite party denies that he did not prescribe any anti allergy medicines. The complainant visited the opposite party hospital on 27.2.2002 and denies that the complainant was in critical condition or in Septic shock and is not aware of the condition of the complainant from 9 a.m. to 4 p.m. and having diagnosed that some internal complications are affecting the body of the complainant and he advised him to consult senior consultant at Karimnagar and therefore he wrote a referral letter to Dr.Mohan Rao at Karimnagar. At the time of consultation on 27.2.2002 the complainant was in complete consciousness and at 9 a.m. of that day his B.P. and pulse rate were normal. Opposite party submit that medical science does not state that a drug allergy will lead to develop into Gangrene . because of consumption of medicines. He denies all other contentions of the complainant and submits that there is no negligence on his behalf.
The District Forum based on the evidence adduced i.e. A1 to A104 and B1 to B3 and the pleadings put forward allowed the complaint directing the opposite party to pay Rs.4 lakhs in all with 9% interest p.a. from the date of petition i.e. 30.5.2003 and costs of Rs.1000/- within one month from the date of receipt of the order.
Aggrieved by the said order, the opposite party preferred this appeal.
The learned counsel for the appellant submitted that Ex.A1 evidences that the treatment given includes anti allergy medicines and the finding of the District Forum that PW.3 has treated the complainant is a sole drawn presumption and the said finding is against record and evidence. PW.3 is a surgeon who has conducted surgery in consultation with PW.2 who has treated the patient. Gangrene developed between 21.2.2002 to 27.2.2002 and there is no evidence infact that a gangrene developed because of any drug allergy and that the question of filing of discharge summary does not arise since the complainant was not admitted in the appellant hospital as an inpatient . The learned counsel further contended that the opposite party doctor saw the patient on 27.2..2002 at 9 a.m. and not at 11 a.m. and the patient went to Karimnagar which is only 50 k.m. away only at 4 p.m. and thereafter joined Yashoda Hospital on 28.2.2002 i.e. next day at 6 p.m. and therefore there is a long time lapse and the appellant doctor cannot be made liable for the events that might have happened from 27.2.2002 9 a.m. to 28.2.2002 6 p.m. The medicines Roxitab is an anti allergy drug and it was prescribed by the appellant doctor on 25.2.2002 and therefore there is no negligence on behalf of the appellant doctor.
The facts not in dispute are that the complainant visited the opposite party on 21.2.2002 complaining fever and headache and the following medicines were prescribed to him for the following reasons :
Sl.No. Name of the drug Nature and Cure
1.
Tablet Codroxil Antibiotic
2. Tab.
Medomol Paracetamol for Fever and Anti-inflammatory
3. Tab Bonacid Forte to control Eenofilia
4. Tab Denim Nimuslide/Head Ache
5. Tab Serbin Forte B.Complex for strength It is the case of the complainant that he developed rash and allergy over the body and visited opposite party doctor on 25.2.2002 but the opposite party doctor did not prescribe any anti allergy medicines and therefore his body was turned black and he was in critical condition and he once again met the opposite party doctor on 27.2.2002 and he was referred to senior doctor at Karimnagar where he reached at 4 p.m. and this doctor advised him to go to Hyderabad hospital for better treatment and he was admitted in Yashoda Hospital, Hyderabad on 28.2.2002 at 6 p.m. It is the further case of the complainant that he was treated as in patient at Yashoda Hospital from 28.2.2002 to 21.3.2002 and he was once again admitted in Yashoda hospital on 8.5.2002 on account of gangrene of both feet and amputation was done and he was discharged on 15.5.2002. From 15.5.2002 to 2.8.2002 he continuously went to Aparna Hospital, Karimnagar for dressing and on 3.7.2002 he got admitted in Yashoda Hospital, Hyderabad again for skin grafting and was discharged on 16.7.2002 and he still undertaking the treatment. It is the main contention of the complainant that had the opposite party doctor given him proper anti allergy medicines and treated him properly on 25.2.2002 when he approached him with rashes all over his body he could not have resulted in gangrene and amputation of his feet. Ex.A1 evidences that when the complainant went to opposite party doctor on 25.2.2002 he was prescribed Roxitab 150 which is an anti allergy medicine as contended by the opposite party . The doctor had carefully written the case of Maculo Popular rash all over the body on 25.2.2002. So it is an admitted fact that the complainant went to the appellant doctor on 25.2.2002 complaining rash all over his body. Ex.A9 which is the Discharge Summary of Yashoda Hospital shows that the date of admission is 28.2.2002 and date of discharge as 21.3.2002. The diagnosis is as follows:
BILATERAL BRONCHOPNEUMONIA, ARDS IMPROVED SEPTICAEMIA WITH SEPTICAEMIC SHOCK IMPROVED DIC IMPROVED PERIPHERAL GANGRENE OF BOTH FEET - REQUIRES FURTHER MANAGEMENT In the history of the patient it is stated that the complainant was suffering from Maculo Popular rash for 5 days, loose motions & Nausea for two days, breathlessness for one day. At the time of admission the patient was in shock with no recordable pulse or BP . On discharge the patient was clinically normal except for dry gangrene both feet, fever for which requires further management. The patient wants to go home and come back at a later date. Ex.A10 is again discharge summary of Yashoda Hospital, the date of admission being 8.5.2002 and date of discharge is 13.5.2002 and in the history of the complainant it is stated as follows:
Patient was apparently normal 45 days back then developed drug allergy and went into hypotension. Patient got admitted in the hospital. Developed bluish discoloration of both upper and lower limb, gradually localized in both foot, developed into gangrene. The foot was incised 15 days back and regular dressing was done.
Ex.A11 is the discharge summary wherein admission date is mentioned as 3.7.2002 and date of discharge 16.7.2002. In this also the patients history is stated as follows:
Patient had undergone transmetotarsal amputation on 08/05/2002. Patient developed drug allergy went into hypotension developed bluish discolouration of both feet which progressed to gangrene, hence amputation was done. Patient presently admitted for skin grafting.
In the discharge summary Ex.A12 dt.18.4.2002 the history of the of the patient is stated as follows:
Patient was apparently normal 45 days . Developed drug allergy 45 days back and went into the Hypotension and admitted in Yashoda.
Patient developed bluish discolouration of both upper limbs & LL 40 days back.
Gradulaly / & localized in both foot and developed gangrene .
The foot was incised 15 days back and regular dressing done.
It is apparent on the face of the record that the patient was normal without any drug allergy when he visited the appellant/opposite party doctor and that the drug allergy developed only between 21.2.2002 to 27.2.2002. Ex.A17 is the complete blood picture wherein WBC showed Neutrophilic Leucocytosis with Toxic Grannules i.e. infection has already settled by 28.2.2002. The contention of the appellant that there was a long time gap between 27.2.2002 and 28.2.2002 when the complainant was admitted in Yashoda Hospital and therefore there is no evidence that the drug allergy had developed during that period and if it had led to gangrene is unsustainable in the light of Exs.A9 to A12 which are all the discharge summaries of Yashoda Hospital which clearly evidences that the drug allergy indeed developed between 21.2.2002 and 27.2.2002 when he was under the care and treatment of appellant/opposite party doctor. The main point for consideration is whether the appellant/opposite party doctor had taken due care and precautions when dealing with drug allergy. The prescription Ex.A1 shows that on 25.2.2002 Roxitab, Medomol and vomiteb medicines were prescribed for allergy , fever etc. Ex.A9 shows that the patient developed gangrene in both feet by 21.3.2002 the date of discharge when he first joined Yashoda Hospital where the doctors in their discharge summary stated that the patient was clinically normal except for dry gangrene for both feet and fever for which he required further management. The patient wanted to go home and come back at a later date. So this evidences that the drug allergy did developed into infection, Septicaemia and thereafter dry Gangrene of both feet.
PW.2 and PW.3 who treated the complainant, in their chief examinations explained the meaning of septicemia and deposed that only because of septicemia the complainant developed profound shock which means that the complainant had very low blood pressure which resulted less blood flow to the feet resulting in gangrene. The appellant doctor in his deposition stated that on 27.2.2002 as rash subsided and the patient was complaining some respiratory problem and he thought that there might be some inner complications and referred the complainant to senior doctor Mohan Rao, at Karimnagar. He states that he did not mention in Ex.A1 that on 27.2.2002 that there were any complications. He did not file any medical literature to support that the prescription he has given is as per the standards of medical parlance.
Dr.Upendra Rao who was examined as PW.3 and who treated the patient deposed that he cannot say that under what circumstances the patient developed gangrene. The appellant doctor admits that he did not call or speak to Dr.Mohan Rao who he had referred the patient, about the condition of the patient. Dr.M.Venkateswara Rao who deposed as PW.2 and who treated the patient at Yashoda hospital stated that the complainant was in speticaemic shock and had Maculo Popular Rash all over the body. But the appellant doctor N.Narayana who treated the patient clearly deposed before the Forum that he did not mention about the subsiding of the rash on 27.2.2002 and also did not state about the respiratory problems and denies that the rash did not subside . This is contrary to the history of the patient stated in the discharge summaries evidenced under Exs.A9 to A12 wherein it is clearly stated that the patient had been admitted because of drug allergy Macro Popular Rash all over the body. When it is the case of the appellant doctor that Roxitab is an anti allergy drug and he has treated the patient as per the standards of medical parlance the burden of proof shifts on him to evidence that the treatment accorded by him to the patient for drug allergy is as per the accepted standards of medical parlance.
It is apparent on the face of record that the complainant suffered from Septicaemia on account of drug allergy which he developed under the treatment of appellant doctor but however if the amputation of both feet is on account of that infection/gangrene necessitating only because of drug allergy is questionable since Ex.A9 evidences that inspite of development of gangrene the patient himself voluntarily wanted to leave and come back again and Ex.A10 is dt. 8.5.2002 i.e. six weeks after his discharge on 21.3.2002. In this period of time the complainant is silent about the treatment accorded to him or the care and precautions taken by him. Therefore to directly establish nexus between the drug allergy and amputation of both feet without any evidence with respect to the treatment between 21.3.2002 and 8.5.2002, is unsustainable. However the act of the opposite party in not even writing on the prescription the history of the patient or the condition of the patient and admittedly not filing the medical literature in support of his case at that point of time the right line of treatment is correct and as per the standards of medical parlance we hold that the appellant/opposite party doctor has been negligent in not rendering proper care to the complainant when he developed drug allergy which developed into speticaemic shock. Therefore while we agree with the observations of the District Forum with respect to drug allergy and the resultant septicaemic shock , in the absence of any evidence of the treatment between 21.3.2002 and 8.5.2002 when the complainant came back to Yashoda Hospital for amputation, we are of the considered view that no direct nexus can be established between the treatment rendered by the appellant opposite party doctor and the resultant amputation of both feet However for the drug allergy which resulted in septicaemic shock and the lack of any evidence on record to state that the doctor has prescribed the right anti-allergy drug or taken proper precautions as per standards of medical care we are of the considered view that the compensation awarded by the District Forum can be reduced from Rs.4,00,000/- to Rs.1,50,000/- to meet the ends of justice while we confirm the rest of the order of the District Forum .
In the result this appeal is allowed in part reducing the compensation awarded by the District Forum from Rs.4 lakhs to Rs.1,50,000/- while confirming the rest of the order of the District Forum . Time for compliance four weeks.
Sd./PRESIDENT Pm* Sd./MEMBER