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There is a great deal of controversy as to whether proper hospital services were rendered to Amit and was Dr. Nathan negligent when Amit walked into the hospital on 6.1.1992 at 3.30 PM and came out dead at 7.30 PM on 8.1.1992? He was admitted for the treatment of epilepsy but mode of death is described as Terminal Cardio-Respiratory Arrest on account of septicemia preceded by viral encephalitis which is stated to be the cause.

Complainant, father of Amit, mourns that on account of the negligence of the Hospital and Dr. Nathan he lost his only son.

He made a claim of Rs.9,22,390/- as compensation against both. Hospital says it took all possible steps in rendering proper medical service to Amit and no negligence could be attributed to it.

Dr. Nathan also says that he treated Amit with all reasonable care and he was not at all deficient in his treatment of Amit. The stark question is as to how a boy of 13 years of age who attended his school regularly upto 3.1.1992 and entered the Hospital on 6.1.1992 under the care of Dr. Nathan for treatment of epilepsy could die within 48 hours of his admission of septicemia. To us it appears here principles of res ipsa loquitur (things speak for themselves) may apply. State Commission has held both the Hospital and Dr. Nathan blameworthy and awarded compensation to the complainant, father of the deceased, as aforesaid. In the complaint it has been alleged that immediately when Amit was admitted in the Hospital four injections were given to him by the resident doctor. Complainant says he was quite surprised as to why there being no diagnosis and within 10 minutes of the admission Amit should have been given four injections. He says when Dr. Nathan visited the Hospital at about 4.30 PM on the day of admission, he was quite annoyed as to why injections had been given. He advised giving an injection of Largactil. Complainant says immediately on giving the injection Amit became unconscious. After seeing Amit for about a minute Dr. Nathan left.

Dear Dr. Nathan, In view of persistent fever will you like to review the case once again. In his affidavit Dr. Deshmukh says that when he examined the patient on 8.1.1992 he was conscious. This could not be so. He did not record this fact in the medical record. Rather when we examine his statement with reference to the Hospital record of 8.1.992 and the statement of the complainant that bed sores had developed on the back of Amit which clearly suggest that Amit was either semi comatose or unconscious or immobilised statement of Dr. Deshmukh stands falsified. When on 7.1.1992 Dr. Nathan found that Amit was feverish he referred Amit to Dr. Pai and at the same time administered injection of Largactil. Dr. Pai in his affidavit says that he could talk to the relatives of Amit about his history of illness. He also says that he found Amit drowsy and when aroused he could talk coherently and he allowed Dr. Pai detailed examination. We are unable to subscribe to this part of statement of Dr. Pai that he found Amit drowsy and who could be aroused. This type of statement of doctor to help each other is not uncommon but given the facts of the present case we are inclined to accept the statement of complainant that Amit was not conscious right from the administering of Largactil on 6.1.1992 till his death. Dr. Pai found that Amit was having mild fever, a slight throat secretion etc. and advised antibiotic. Hospital record does not show what Dr. Pai found except his prescribing ampicillin. These antibiotics he advised to be given to Amit through intravenous route. Dr. Pai says he also instructed RMO and the Nurse on duty to start I.V. drip of Isolyte M with M.V.I. (Vitamin Injection) and Redoxan (Vit.C) added to it. Dr. Pai examined Amit on the morning of 8.1.1992 and he says that he found the condition of Amit same as that existing in the previous evening except that his fever had arisen. He says he instructed RMO to increase the dose of injection of ampicillin. He advised X-ray of the chest and ordered for lumbar puncture test. He says clinically he noticed that Amit had not any sign of Meningitis. Chest X-ray was normal and did not show any abnormality. Lumbar puncture was also normal. Thereafter it appears Dr. Pai had no occasion to examine Amit and he says subsequently in the evening he was told of sudden deterioration in the condition of Amit and whatever steps Dr. Nathan took to treat patients as told by Dr. Nathan himself. At about 12.00 Noon lumbar puncture was done and X-ray of chest taken. Then the record shows that Amit was unconscious. His pupil were reacting to light. Dolls eyes present and that there was no response to stimuli. Amit was having laboured breathing and his temperature was 102 degree FH. Certain treatment was prescribed when at 4.30 PM it is recorded that the child was ready for ECG. At 5.30 PM onwards the condition of Amit is recorded and at 7.30 PM he was shown as having died and cause given is Septicemia with viral encephalitis. Relatives of Amit were informed of the death and so Dr. Pai and Dr. Nathan. Death certificate has been issued by resident medical doctor of the Hospital.

He did not return because of pressure of work and was informed of the death of Amit at Hindu Sabha Hospital by Dr. Vivek Chitlange. Dr. Pai contradicts Dr. Nathan squarely. He does not say that he was there in the ICU when Dr. Nathan left. As to what was more pressing engagements than looking after the patient who was dying Dr. Nathan had not disclosed. Dr. Nathan then said that nycil powder was not advisable for bed sores. He was non-committal as to what treatment was given by the Hospital to control the bed sores. According to Dr. Nathan the cause of death was septicemia with viral encephalitis . Amit was not suffering from any such disease at the time of admission. Dr. Nathan admits that septicemia could not be contacted suddenly and that there has to be some incubation period which could be days and weeks before the first sign of septicemia infection might occur. According to Dr. Nathan cause of septicemia was the infection of lungs. He admits that Amit was admitted in the Hospital for observation of fits. Hospital record of 8.1.1992 shows that Ryles tube was applied to Amit. Dr. Nathan says that the tube was not inserted at his advice. No doctor is taking responsibility as to who advised for insertion of Ryles tube. Though according to Dr. Nathan Ryles tube was inserted under the instruction of Dr. Pai and the Medical Registrar of the Hospital, Dr. Pai is silent about giving any such instruction. We have already held that Amit was in unconscious stage. In the absence of any evidence we are not considering the allegation of the complainant that inserting Ryles tube in semi comatose condition is almost inviting complications like aspiration pneumonia and sudden death. But we are not getting the answer as to who advised insertion of Ryles tube. That itself is pointer to negligence by the Hospital. Dr. Nathan admitted that Largactil injection and tables did have side affects and one of that was sedative. He also admitted that in case of over dose of Largactil patient could develop pneumonia. Dr. Nathan says he prescribed Largactil injection as Amit was violent and that this injection is prescribed to a patient who is in psychological distress. When asked as to why post mortem was not conducted on the body of Amit, Dr. Nathan said it was not necessary as in his opinion he knew what was the cause of death. When lumbar puncture is reported to be normal this makes viral encephalitis highly unlikely as there must be increase in the white blood cell count in the CSF (should be 75 WBC in CSF). The record shows that WBC count was also normal. Therefore septicemia is also highly unlikely (WBC count should be high or very low in septicemia). When condition of Amit became worst he was transferred to ICU where Dr. Vivek Chitlange, an Ayurvedic trained doctor was incharge. There is nothing in the Hospital record to show if any supportive management was maximised to treat the patient.