Medico Legal News
( Physician)
Dear Doctor,
Our effort is to provide you with the latest and relevant developments in the field of medico legal services for this we are providing you some case references from the field of Physician.
13-55 PHYSICIAN/GENERAL PRACTITIONERS
13-55.1 Physician/General Practitioner- Test injection-Death of patient- Treatment free of charge-Complaint outside purview of Consumer Protection Act-Wife of the complainant got treatment from a doctor who was a family friend. The doctor administered some test injection following which the patient fell unconscious and subsequently died. It was held by the State Commission, since the doctor gave the treatment free of charge, the patient was not a consumer and the complaint is outside the purview of the Consumer Protection Act.1 [Mappooyan v. Dr. Premavathy Elango,1991 (2) CPR 460 (TN SCDRC).]
13-55.2 Physician/General Practitioner-Snake bite-Death-No evidence adduced-No negligence-Complaint dismissed-The complainant's brother was bit- ten by a poisonous cobra, and was admitted to the opposite party hospital, where he died. It was alleged that the death was due to negligent treatment. After giving sufficient opportunity to examine witnesses, the State Commission disposed of the case on the basis of material on record, and held that there was no negligence in treatment. Complaint dismissed. [A. K. Pias v. KarithasHospital, 1992 ( 1) CPJ 182 (Ker . SCDRC).] c, 13-55.3 Physician/General Practitioner-Providing service in rural areas- Case referred to higher center-No negligence-.In the instant case, the State Com- mission while dismissing the complaint ruled that the nurses and doctors providing services in the rural areas had given full medical attention and timely referred the case to higher authority as it required blood transfusion. The Commission also noted that in the distant villages where the modern facilities are not available and the doctors have to treat the patients with available means and resources, if wild allegations of negligence are made, time will come when no doctor will take the patients in the hospital even if they are serious and will hesitate to give even primary treatment and thereby expose himself to wild allegations of negligence and dragged into the court. [ Vag hri Gopalbhai v. Parmar Navalben Balabhai & Anr., 1993 (1) CPR 526: 1993 (2) CPJ 1038 (Guj. SCDRC).]
13-55.4 Physician/General Practitioner-ARV treatment-Neuro-paralytic re- action-Death-No negligence-. The complainant's son was bitten by a cat, and taken to opposite party No.1,
where Anti-Rabies Vaccine (A.R.V.) course was administered. But he developed gradual weakness of the lower limbs and was hospitalised in the I.C. U . It was alleged that due to negligence in treatment he died. The State Commission on basis of standard text-books and W .H.O. technical report of 1984, held the A.R. V. administration was in line with the standard recommendations and the neuro-paralytic reaction, a well-known complication of this treatment led to
.                     The position has since changed after the Supreme Court judgment in hldian Medical Associatil V. P. Shantha & Ors., 1995 (3) CPR 412: AIR 1996 SC 550: 1995 (3) CPJ 1: 1995 (6) SCC 651: JT 1995 (8) SC 119 vide which the persons getting treatment from a doctor/hospital who charge fee from some patients and provide free treatment to others are consumers under the Consumer Protection Act. death of the patient. The complaint was dismissed. [Dipti De Sarkar v. Steel Authority oflndia Ltd., Rourkela Steel Plant & Ors, 1993 (1) CPR 640: 1993 (2) CPJ 1289 (Ori. SCDRC).] ]
 3-55.5 Physician/General Practitioner-Gastroenterologist-Haemate. mesis-Treatment by Sengstaken's tube with traction-:-Two forms of treatment available-Adopting anyone form-No negligence-Complainant admitted in nursing home for treatment of Haematemesis (vomiting blood). Negligence was alleged as instead of doing endoscopic sclerotherapy, the opposite party introduced Sengstaken' s tube with traction, causing physical pain, agony and torture. The points considered by the State Commission were: whether it was a proper method and discretion exercised by the doctor? .whether there was deficiency of service and negligence? Held:There is no dispute that sclerotherapy and Sengstaken's tube methods are both recognised methods of management in the case of upper gastrointestinal bleeding. As pointed out by Mr. Justice Barrie in Moore v. Lewisham Group, HNC (1959), when there are genuinely two responsible schools of thought about management of a clinical situation, the Courts could do no greater disservice to the community or the advancement of medical science than to place the hallmark of legality upon one form of treatment. Out of these two well recognised forms of treatment, the opposite party who has rich experience in dealing with acute cases specifically those of gastrointestinal bleed-up- per and lower-has thought that Sengstaken' s tube was the proper method and discretion exercised by him is not liable to be challenged in the Court of law. As a matter of fact this treatment has been successful and the bleeding in the second complainant has been arrested. We have therefore no hesitation in holding that the treatment rendered by the first opp. party to the second complainant by introducing Sengstaken's tube instead of endoscopic sclerotherapy was aright and proper method and there is no deficiency of service or negligence on the part of the first opp. party.
The complainant also alleged that the first opposite party had transfused 6 units of blood when so much was not needed and this produced overloading of her lung, and heart and precipitated cardiac decompensation. The question considered was: whether there was deficiency of service and negligence on the part of opposite party.
There was held to be no deficiency in service (negligence) on the following grounds: .There was no independent medical evidence to show that there was over-administration of blood. The case sheet did not indicate cardiac decompensation or lung crepitations. In the circumstances held, that there was no deficiency of service. One of the contentions of the complainant was that though her eldest son and daughter with the same blood group were ready to donate blood, the opposite parties took blood form the blood bank and this was improper. The law point considered was whether the opposite party was justified in administering blood received from blood bank?
Held: Normally relations are asked to donate blood, but in case of emergency like the present one, the blood bank is requested to supply blood. ~oreover, 6 units of blood were given and the complainant's son and daughter could not have donated so much of blood at that time. Further, the blood received from the blood bank being already screened and could be given to the patient directly in emergency cases which could not be possible in case of blood taken from close relations. [Dr. N. T. Subramanyam & Ors. v. B. Krishna Rao & Willingdon Nursing Home, 1993 (3) CPJ 1557 (TN SCDRC)]
In an appeal against this order of the decision of the Tamil Nadu State Commission and dismissed the appeal. [Dr. N. T. Subramanyam v. Dr. B. Krishna Rao, 1996 (2) CPJ 233: 1996 (2) CPR 247 (NCDRC).]
13-55.6 Physician/General Practitioner-Fever- Treatment given-Patient died-No negligence-But insurance company with which doctor was insured persuaded to pay Rs. 75,000 compensation on compassionate grounds -The complainants, brothers and parents of Ramesh claimed the amount of Rs. 6 lac from Dr. Suresh  Parikh for causing death of Ramesh a student staying in a hostel. Ramesh who fell ill for 2/3 days was taken to Dr. Parikh who prescribed some medicines and injected Injection Baralgan 2 cc intramuscular. After this Ramesh complained of difficulty in vision and was subsequently taken to another Dr. Rathod where treatment was given but he died after ten minutes. Dr. Parikh denied that Ramesh had complained of any difficulty in vision, nor was there any evidence of reaction. After one hour he advised to take Ramesh to Government Hospital. It was held that the complainants had not been able to establish from the evidence of Dr. Rathod that the death was due to injection or any other treatment given by Dr. Parikh. No other evidence was produced. As Ramesh was suffering for 2/3 days, it was quite possible that it might be natural death. Hence, Dr. Parikh was not negligent.
However, during the course of the proceedings it transpired that Dr. Parikh was covered by insurance policy and therefore, the Commission through Dr. Parikh's advocate persuaded the Insurance Company to pay Rs. 75,000/- to the complainant on compassionate basis. [Haribhai Lagharbhai Salon v. Dr. Suresh Parikh, 1994 (1) CPJ 373 (Guj. SCDRC).]
13-55.7 Physician/General Practitioner-Treatment for fever, pain in throat, etc.-Development of Stevens-Johnson Syndrome-No negligence-In the instant case, the complainant was treated for fever, pain in throat and itching in eye, with some oral drug and injections. Subsequently she was referred to an Infectious Diseases i Hospital which diagnosed her ailment as Stevens-Johnson Syndrome (SJS) a severe form
Iotdrug reaction. It was alleged that due to wrong diagnosis and treatment she developed SJS, which resulted in loss of her eye-sight. The State Commission held that there was no evidence to indicate that the patient developed SJS as a result of the medicine and the injections prescribed by the opposite party and dismissed the complaint. [ Geeta Kumari v. Anita Ranjan, OP No.98 of 1992 decided on 6.1.1995 (Ker. SCDRC).]
13-55.8 Physician/General Practitioner- Treatment for fever-Stevens- Johnson Syndrome occurred-Many reasons for occurrence of Stevens-Johnson Syndrome-Complaint dismissed- The complainant had an attack of fever for which she was given some medicines by the 1st opposite party. It was alleged that due to this treatment she developed Stevens-Johnson Syndrome (SJS) leading to damage to both eyes, one of which had to be removed.
The State Commission held that as Standard Text-Books of Dermatology mention clearly that SJS could occur also due to other reasons, it could not be established that SJS was caused by medicines given by the Ist opposite party. Also, the diagnosis at the Medical College Hospital was not definite. Complaint dismissed. [ Cheroth Suhara v. Dr. K.K. Subramaniam & Anr., 1995 (1) CPR 258 (Ker. SCDRC).]
13-55.9 Physician/General Practitioner-Upper abdominal infection-Inflated claim-Misuse of Consumer Protection Act-Costs to doctor and hospital- The complainant alleged that he suffered heart attack, which was not diagnosed by the opposite parties, and instead he was treated for other ailment due to which his heart had been damaged and claimed compensation of Rs. 55.9 lac. On careful consideration of the evidence adduced in the case, the National commission held that the complainant had severe upper abdominal infection and due to prompt and expert treatment he was saved from what might otherwise have led to his death on account of septicaemia. No negligence, lack of reasonable skill, care and caution or deficiency in service of any kind has been established, and dismissed the complaint with costs of Rs. 10,000 payable to both the opposite parties separately for indulging in speculative litigation and misusing the provisions of the Consumer Protection Act. [Brij Mohan Kher v. Dr. N.H. Banka & Anr. 1995 (1) CPJ 99: 1994(3) CPR 197 (NCDRC).r 13-55.10 Physician/General Practitioner-Wrong treatment-Allegation of Stevens-Johnson Syndrome development-No evidence to establish-Complaint dismissed- The complainant went to the opposite party for fever and redness of the eyes. Medicines and injections were given, but it was alleged that she developed complications due to wrong treatment and drug reaction, and ultimately lost vision of her eyes, on account of development of Stevens-Johnson Syndrome (SJS).
The State Commissions held that there was no evidence to indicate that the patient developed SJS as a result of the medicines and the injections prescribed. The burden is on the complainant to establish that it was on account of the negligence or deficiency in service on the part of the doctor that the complainant developed SJS. The complainant had failed to establish this. The complainant also failed to examine any of the doctors who subsequently treated the patient. Complaint dismissed. [ Geetha Kumari v. Dr. Mrs. Anita Ranjan, 1995 (2) CPR 393 (Ker. SCDRC).] ~ r
13-55.11 Physician/General Practitioner-Paralysis-Face and right ;tand- .
In complete recovery of right hand-No negligence-The complainant a stenographer suffered facial paralysis and paralysis of right hand. His facial paralysis disappeared with the treatment of 1st opposite party, but the recovery of his right hand was not complete. It was alleged that the opposite party No.1 was negligent in not advising physiotherapy and in not referring him to neuro-physician.
The State Commission held that there was no evidence supported by Medical Experts to establish that the treatment given was improper or that such treatment was only given to recover fees from the complainant, and dismissed the complaint. [ 1 shwar Das Lakhraj Ramchandani v. Dr. P.J. Buch & Anr., 1995 (3) CPJ 549 (Guj. SCDRC).] r
13-55.12 Physician/General Practitioner-Haematologist-Aplastic anaemia following treatment-No negligence-In the instant case, it was alleged that Dr. Shah knew that applicant was hypersensitive to chloroquin phosphate and its derivatives. Previously Dr. Shah had treated complainant for Malaria and prescribed Malocid tablets. Again the appl icant had fever in August, 1992 and the opposite party advised the applicant to take same medicine again. However, the temperature did not come down. The opposite party examined the applicant in a casual manner without blood/urine test, prescribed some other tablets of sulfa group. However his condition deteriorated.
The applicant thereafter got himself admitted in a hospital but could not get any relief and the concerned doctors referred him to Dr. Divyesh Mehta, Hematologist. ' According to applicant he recovered because of treatment given by Dr. Mehta. Also applicant states that in opinion of Dr. Mehta the ailment from which applicant was suffering was due to administration of drugs. The applicant alleged that even though the opposite party knew that quinine was harmful drug he gave doses of quinine and sulfa drugs. Therefore, the complainant suffered both physically and mentally. He alleged that he had suffered physical and mental disability and his sex life had also suffered, and claimed sum of Rs. 6,85,000/- by way of damages/compensation and interest.
The opposite party denied the claims. The opposite party stated that it is not necessary in each and every case to get blood/urine examined. Also, it was the applicant who was negligent in taking treatment. The opposite party also stated that when the applicant visited him he found that fever was of bacterial origin and, therefore, the complainant was given antipyretic and safest long acting combination and sulfa medicine. According to the opposite party complainant was advised to see him on the next day if he was not relieved of the symptoms. The complainant did not report to the opposite party thereafter. Therefore, the complainant himself was negligent. The applicant again came after about 8 days on complaint of fever with rigors. On clinical examination the opposite party suspected that the applicant was suffering from malarial fever. Therefore, medicine like Malasulf and other medicines were prescribed. The opposite party also stated that he gave directions to the applicant to come again as he wanted to advise some investigations. He, therefore, stated that there was no negligence in treating the applicant. In fact, the applicant himself might have taken some other medicines on his own. The Commission held that the evidence produced by the applicant is not reliable. Also Dr. Divyesh Mehta further deposed that Aplastic Anaemia is a condition where bone marrow is depressed. However, he states that it can occur due to many causes. Amongst the known causes are: infections, drugs, alcohol etc. and sulfa drugs. May be one of the causes. However, Dr. Mehta made it clear that he was not sure whether applicant's ~; condition was due to the administration of the drugs sulfa. Dr. Mehta, however, further ~ deposed that above condition of blood could not have been avoided by laboratory test. l' He stated that there is no effective way of predicting as to which patient can react " adversely to the drug. Stated that as an expert he left. That having regard to number of people having malaria It would be counter-productive In terms of costs to the patients to order widespread tests. Therefore, he Commission came to the conclusion that Dr. Mehta's report did not help the complainant and it did not prove negligence on the part of the opposite party. In fact Dr. Mehta's report stated clearly that opposite party could not be said to be negligent in not suggesting blood or urine test or X-ray to applicant. Furthermore, applicant's blood count and hemoglobin had come to normal level. Therefore, the applicant had recovered from the ailment from which he was suffering.
The Commission, therefore, held that there was no negligence on the part of the opposite party and case came to be dismissed.