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3. Defence of Dr. Anil M. Gupta vide written version is of total denial. There is no fault, imperfection or shortcoming or inadequacy in quality, nature and manner of performance required to be maintained by or under any law for the time being in force. She was under treatment of Dr. Bhagirath Pandya, an Ayurvedic doctor for 10 days for cough and fever. As she was not responding and developed breathlessness, he referred her to him on 25.10.2010 for E.C.G. She came with some tests reports and she was immediately, attended to. The ECG was showing tachycardia and on clinical examination, she was obese and had bilateral ronchi & creps and mild distention of abdomen. Looking to her poor general condition and report the provisional diagnosis of septicemia + anemia was made. Therefore, she was advised to get admitted in the hospital and explained the proposed line of treatment and pros and cones also. The patient and his relatives agreed to that and therefore, she was admitted in his hospital, blood and urine samples were sent for pathological tests (CBC, RBC, S.Creatinine, SGPT & Urine -R&M). Looking to the condition of the patient, he told the complainant to arrange for the blood. Necessary treatment with injections started immediately. On 26.10.10, the test reports were also suggestive of septicemia + anemia. The X-ray chest and 2D Echo were also done and the report was suggestive of COPD & pleural effusion. Therefore, looking to poor general condition of the patient he advised to shift her to a well equipped hospital (OP.2) for which the patient and her relatives were agreed and the patient was shifted to Anand hospital on 26.10.2010. She was shifted there on 26.10.2010 for further treatment under his care, arranged for the two bottles of blood and that was transfused, and she was monitored round the clock and necessary medicines were given with another blood transfusions. Pathological test and certain investigations were also carried out as per accepted medical norms. He also suggested for the Dengue test which was carried out on 29.10.2010. The same was found positive. He thereafter, had taken the advice of Dr.Rajesh Mishra -OP.3 (Intensive care specialist). He conveyed all the details of treatment and the history of the patient to the opponent no.3 doctor. The opponent no.3 visited his Hospital. The opponent no.3 examined the patient and approved the line of treatment and suggested few changes. He also advised to shift the patient to the opponent no.4 hospital under his care. The patient and her relatives agreed for th at the patient was shifted to OP.4 hospital. He submits that he had treated as per accepted medical practice and therefore not a guilty for any negligence or deficiency in service. It is denied that he availed benefits of mediclaim insurance facility of the complainant using unfair means and in unethical manner, or that did not take reasonable care while treating her, or that ultimately death of her has caused irrecoverable loss to him and he is feeling loneliness at his young age. He was in constant consultation with the doctor on duty at Anand Surgical Hospital and the doctor on duty was given treatment to the patient as per his advise. It is denied that the doctor on duty informed the complainant that patient seems to have internal infection as a result of which her hemoglobin level is reduced. It is denied that he first time confirmed damage to lung after seeing the report. In fact, as per clinical findings on 25.1.2010, she had ronchi & creps and the provisional diagnosis was septicaemia + Anaemia. That was confirmed as stated above by blood reports and X-ray and Echo. Because of monitoring and the follow-up tests reports, it was found that her liver and kidney function was distorted and that was explained to the complainant off and on. As patient was not responding much to the treatment he carried out Dangue Test on 29/10/10 and that was positive. He denies that the internal infection that was observed by the doctor on duty, had caused serious damages to her and it seems to have been gone un-noticed by him. Immediately Dr.Mishra, intensive care specialist was consulted. He denies that because of carelessness and casual approach of opponent no.1, the underlying cause of illness of her seems to have not diagnosed-properly and resultantly she is suffering lot and the real treatment is thus delayed. He denies that before any real line of treatment is thus selected, the said ailment had caused further damage to the health of her. He denies to have continued with the same line of treatment except few minor changes with regard to administration of medicines here and there. He denies that despite receiving consideration, the opponent remained careless all throughout and failed to e ven diagnose the underlying cause of sufferance. He denies that either willingly or otherwise, he never disclosed correct facts and tried to suppress the ailment from which she was suffering and thereby deprived the complainant to take reasonable, appropriate and timely decision in a prudent manner which could have saved her life. He denies that her life could not be saved just because he remained careless and negligent in performing their parts of duties, and that there was deficiency in service.

10. Dr. Anil Gupta in interrogatory answers to the effect that he owns hospital at Krishnanagar; knows Dr. Bhagirath Pandya who occasionally refers him patients; the complainant consulted him for the first time for treatment of his wife on 25 th October; she came walking and with reference note of Dr. Pandya. He immediately examined him; it is standard practice to make note of relevant points of the complaints and clinical symptoms or ailments observed by doctor when the patient is examined for the first time. Page 13 is the same note he made the same day. She came with reports of CBC, blood urea, S. Creatinine, S. Protein, Bl. Glucose and Urine. Diagnosis was COPD + Anemia as per history, clinical findings and investigation reports including ECG, and he advised hospitalization. He has not placed on record case papers of treatment during indoor hospitalization, and case papers are attached. He advised blood transfusion as her Hb was only 7g. and ECG was showing Tacchycardia. It is not true that patient‟s relatives arranged blood bottles on 25th and answers that they brought bottles on 26th at Anand Hospital. He prescribed pathological investigations on 26th and done on the same day. On the basis of pathological investigations, he advised for shifting her to Anand Hospital where 2D Echo was done. It is not that always supplying blood through transfusion would increase internal load and denies that in such a condition the patient may feel pain at chest. Before shifting to the Anand Hospital he gave reference note as well as informed them over the phone. The reference note is on record Pg.14. He admits that when she reached Anand Hospital she was examined by doctor on duty and the doctor on duty had recorded her condition in indoor case papers. It was never asked for however he has produced it here. In Anand Hospital total 4 PCV (blood) was given to the patient. It is true that there was no symptoms or signs of Liver and Kidney damage prior to her hospitalization at his hospital. He denied that her condition was deteriorated only after hospitalization at his own hospital or that he carelessly ignored the information supplied by the doctor on duty at Anand Hospital. He denies that mere clinical findings of ronchi and crepts is not sufficient to diagnose case of septicemia and answers that the ronchi and crept were one of the diagnostic features of septicemia. It is true that pathological investigation carried out at Anand Hospital revealed reduction in total blood counts and answers that it was on 28.10.2010. He denies that he consulted Dr. Rajesh Mishra only when himself found that condition of the patient has set on for irreversible phase. Fever, tachycardia, anaemia not responding to standard treatment were the circumstances that led him to think of possibilities of Dengue. The dengue test was carried out on 29th October only. Medical Officer prepared discharge card and handed it over to her relatives with reference note at page 23. In question that when she shifted to Nidhi Hospital she was not able to respond verbal commands he answers that she was semi conscious. Her abdomen was distended from the day of admission and remained so. To the question that while writing reference note to another hospital or doctor, a referring doctor mentions treatment given and brief history as to condition of the patient he answers not always. He denied that because of his casual approach she had suffered and that because of his carelessness and negligence, her condition deteriorated and lost her life untimely.

17. Now, she was under treatment of Dr. Pandya for 10 days for cough, fe ver; after 4 days complained of difficulty in breathing, was referred by him to Dr. Anil Gupta for ECG. She goes to Dr. Anil Gupta, on 25.10.2010 walking with reports of CBC, blood urea, S. Creatinine, S. Protein, Bl. Glucose and Urine, was diagnose d of COPD + Anemia as per history, clinical finding, and investigation reports including ECG, advised blood transfusion HB being 7g and ECG showin g tachycardia. On clinical examination she was obese and had bilateral ronchi & creps and mild distention of abdomen. Looking to her poor general condition and report the provisional diagnosis of septicemia + anemia was made. Mere clinical findings of ronchi and creps were one of the diagnostic feature of septicemia. She was admitted in the hospital. Blood and urine samples were sent for pathological tests (CBC, RBC, S. Creatinine, SGPT and Urine R & M). The complainant was asked to arrange for blood, and necessary treatment with injection started immediately as alleged. Considering test reports on 26.10.2010 which were suggestive of septicemia + anemia, and X-Ray chest and 2D Echo show COPD & mild pleural effusion, and her condition being poor, she was advised to be and shifted to the Anand Hospital, on 26.10.2010. There doctor on duty as admitted examined her and noted her condition in indoor case papers. Pg. 258 thereof shows patient admitted with complain of dyspnoea since 5 days, fever since 2 days. H/o. severe chest pain before 2 days. P/H/O LSCS 3 times in past obesity. No H/O DM + HT + IHD. H/o allergic bronchitis and findings (pg 255) the same day reads PA: Distended. He admitted there was no symptoms or signs of liver and kidney damage. She remained in Anand Hospital from 26.10.2010 to 01.11.2010, four bottles of blood were transfused. On 26.10.2010 her HB was 6.8, WBC count 22,900, platelet count 1.56 lacks, O2 saturation 74%, mild cardiomegaly in transverse diameter, Right CP angle observed as obscured to favour minimal right pleural effusion without pulmonary congestion or oedema or consolidation, collapse or emphysema but with findings as suggestive of COPD. On 28.10.10 HB was 9.6, WBC 8,900, S. Creatinine 0.94, liver showed mild enlargement, Grade 2 Fatty Infiltration, IVC and Hepatic Veins dilated to suggest congestive changes, Gallbladder Wall Oedema ( 7 mm) mild spleenomegaly, mild right pleural effusion, and both Kidneys as enlarged were seen but without any e vidence of free fluid or of any dilated bowel loop. Fever, tachycardia, anemia not responding to standard treatment were the circumstances that led him to think of possibilities of dengue, the test whereof was carried out on 29.10.2010 only. It showed Dengue IgG and IgM both positive , the same day. On 29.10.2010 her HB was 11, WBC 6,500, Platelet count was 0.99 lac, O2 saturation was 94. He thereafter took advice of Dr. Rajesh Mishra (Intensive Care Specialist), who came and examined. He suggested some changes he alleges. On 31.10.2010 her HB was 13.1, WBC 10,500, platelet count 0.96, and O2 saturation was 91. USG Abdomen: showed dilated bowel in abdomen, no significant peristalsis, minimal interbowel free fluid, gaseous prominence of bowel loops in abdomen, minimum right pleural effusion, Grade 2 Fatty liver with normal size, enlarge both Kidneys with increased echogenicity, Mild GB Wall Obedema, CBD normal, PV dilated measuring 14 mm, mild Spleenomegaly, enlarged U turn in pelvis and pancreas normal. To the question (14) to Dr. Mishra as to when did he advise for shifting her to Nidhi Hospital, his answer is on 01.11.2010, when Dr. Gupta told him on phone that patient was not improving. Dr. Anil Gupta to the question that when she shifted to Nidhi Hospital, she was not able to respond to verbal commands he answers that she was semi conscious; that her abdomen was distended from the day of admission and remained so. On admission to Nidhi Hospital on 01.11.2010, her HB was 12.50, WBC 8,990, platelet count 46,300, S. Creatinine 3.58, reason for admission as fe ver, unconsciousness, abdominal Distension, CNS no response to verbal commands, moving all IV Limbs on painful stimulus, Dengue fever detected at Anand Hospital, was having history of fever, coughing and common cold, vaginal bleeding (off & on) and breathlessness since last 15 to 20 days. Dr. Mishra answers that Distention of abdomen can always be recognized by clinical examination. To the question No.9 that distention of abdomen is one of the sign which may be giving clue for onset/spread of infection inside abdomen he answers not always. When distention of abdomen can be observed there could be many other circumstances like ascities, internal obstruction, paralytic illeus and even due to gas or fat. And agreed that when doctor sees distention of abdomen, he/she has to find out the real cause for distention of abdomen and then to take corrective measures for the same. Diagnosis on discharge from Nidhi Hospital was Dengue Fever with white matter obdema with ARDS with ARF with obstructive sleep apnea + Paralytic illeus.

19. She presented with mild distention abdomen on 25.10.2010. 2D ECO and color Doppler study concluded findings suggestive of COPD on 26.10.2010 which inter alia noted right CP angle is obscured to favour minimal right pleural effusion. Now pleural effusion and ascities were clinically detectable depending on degree of plasma leakage and the volume of fluid therapy. Hence the chest x-ray and obdomenal ultra sound can be useful tools for diagnoses for dengue as indicated by WHO, accordingly to which symptom and sign of respiratory distress, and oxygen desaturation (74% on 26.10.2010) requires close monitoring and management, vide Arunkumar Manglik‟s case (Supra). No such diagnose was made out therefrom for dengue nor any further test to rule it out. She presented with COPD, breathlessness and fever. Dr. Gupta‟s provisional diagnose was of septicemia + anemia. She was 45 years of age. Thus far she was not diagnosed of dengue and seems to have been treated for sepsis, anemia, COPD, but not for dengue, which he doubted only on 29th . He doubted it from very fever, tachycardia, anemia not responding to standard treatment as answered by him. The root cause of sepsis, pleural effusion, abdominal distension was not tried to be found out vide WHO guidelines under clause 2.1.2 critical phase for dengue vide Arunkumar Manglik‟s case (Supra), nor treated the dengue that way at least before it was detected on 29.10.2010. For the complainant it is shown from Harison‟s Principles of Internal Medicine that sepsis is direct cause of COPD. It is argued for Dr. Anil Gupta that you should think of 2010 medical filed, there was no specific medicine to treat dengue infection, if you think you may have dengue fever, you should use pain relievers with acetaminophen, avoiding medicine with aspirin, vide its writeup submitted. The argument is not acceptable. It is for the reason that in Arun Malik‟s case death of dengue fever was on 15.11.2009, and in its para 25 guidelines were referred to of 2008, and that of WHO in para 26 gives stagewise management of the dengue, not only just as argued. Now, failure to use due skills in diagnosis with the result that wrong treatment is given would be negligence, vide Malay Kumar Ganguly‟s Case, III 2009 CPJ 17 (SC) Para 177 (iv), Dr. Kunal Shah Vs. Dr. Sukumar Mukharjee, IV 2011 CPJ 414 (NC) 157 (iv). When she did not respond to treatment of Dr. Gupta he doubted of dengue which in a test were found positive the same day on 29th . The suggestions that Mr. Mishra made on 29th also did not work, hence he telephoned him on 1st November. She was being shifted subconscious from Anand Hospital to Nidhi Hospital, there she was diagnosed on admission of dengue fever, brain white matter oedema, paralytic ileus on 01.11.2010; was found with remote possibility of encephalopathy, on discharge on 09.11.2010, she was diagnosed of dengue fever with white matter Obedema with ARDS with ARF with obstructive sleep apnea + Paralytic ileus. This shows the plight of her condition for failure to diagnose dengue and treat the dengue. All these clearly prove negligence of Dr. Gupta-Opponent No.1.