Case Study

Negligence means and includes Careless State of Mind

Prem Lata v. Dr. Arun Kumar Sinha & Ors.

First Appeal No. 552 of 2015; decided by the Hon’ble National Consumer Disputes Redressal Commission on 9-9-2016.

Facts: It was alleged that the appellant/complainant Prem Lata’s husband, Shri Rakesh Bharti was suffering from cold, headache and mild fever since 27-7-2010 till 2-8-2010.  He took treatment from different doctors and lastly, as per advice of Dr. Thakur R.B. P.N. Singh, he was hospitalized at Rajeshwar Hospital, Patna on 2-8-2010 under care of Dr. Arun Kumar Sinha, and remained indoor patient from 2-8-2010 to 9-8-2010. At the time of discharge, OP 1 prescribed Rabitos-D, a medicine of PPI Group, which caused severe reaction to the patient, was prescribed without proper care. On 10-8-2010, the patient approached OP 1 again but there was no response to his treatment, then on 14-8-2010 he approached OP 2/Dr. Vijay Prakash at Bihar Institute of Gastroenterology, who advised to stop previous medicines. He remained under treatment of OP 2 and another visiting doctor, Dr. S. K. Thakur, OP 3.  On 28-8-2010, OP 3/Dr. S. K. Thakur prescribed medicine Panto D again i.e. the medicine of same PPI group which caused further reaction.  Knowingly, the OPs 1 to 3 prescribed PPI group medicines.  On 29-8-2010, the patient was discharged from Bihar Institute of Gastroenterology and advised to consult Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow for further management of Steven’s Johnson Syndrome, wherein the patient was diagnosed as Steven’s Johnson Syndrome and advised for hospitalization but due to paucity of bed, the patient could not get admitted at SGPGI, Lucknow.  He was again admitted in Bihar Institute of Gastroenterology under care of OP 2 on 31-8-2010, again prescribed Pantodec 40 upto 3-9-2010, which caused adverse reaction; patient developed fresh erythematous spots on other parts of the body.  On 3-9-2010, Dr. Sudhanshu Singh stopped the medicine Pantodec-40.  The redness went on increasing and exfoliative lesion started developing from 6-9-2010.  Thereafter, Dr. Vijay Prakash/OP 1 and OP 3/Dr. S. K. Thakur stopped entertaining the patient and pressurized him to vacate the bed immediately.  From 7-9-2010 to 13-9-2010 the patient was not attended by any doctor, but the compounder and nursing staff of the hospital were looking after the patient.  Thereafter, the patient was taken to Shri Ram Hospital Patna on 13-9-2010 where he survived till 20-9-2010. The State Commission after hearing the parties dismissed the complaint.

Defence: There is no expert opinion to show that the drugs were administered negligently, medical records dated 27-7-2010 showed that the patient consulted Dr. Shailendra Kumar, a physician; on 29-7-2010 the patient suffered jaundice, consulted one Dr. Bir Prakash Jaiswal, a Pediatrician who advised complete bed rest and soft diet. On 2-8-2010 the patient approached Dr. Thakur R.B.P.N. Singh who also recorded that the patient had jaundice, itching over body and fever.  On examination, there were rashes all over the body.  Then, the patient was referred to OP/Dr. Arun Kumar Sinha on 10-8-2010 wherein he was advised Rabitos-D.  The clinical notes revealed that there was no history of known allergy.  Dr. V. P.  Singh took dermato-logical consultation and started IV fluids and proper antibiotics alongwith steroids and local creams.  The patient was followed up daily in Bihar Institute of Gastroenterology from 18-8-2010 to 29-8-2010; was monitored with regular investigations like Liver Function Test; in the course of treatment, the patient developed erythematous rashes over the back.  The discharge summary clearly mentioned about the treatment aspects:

“Hospital course managed with:-  (1) Inj. Dexona Avil, Kenacort, Pantodac, Albumin, Vit-K (1 bottle) (2) Inj. Mikacin, Augmentin (3) Tab. Ursocol Lumetherfort DT, Liverubin, Omnacortil, Ridar, Microcef DT, Biosuganril (4) Cream – Halox, Hidrate, Elovera, Soframycine (5) Cap. Z & B (6) Eydrop – Betnesol, Neosperine, Nebrain (e/o) DM, Systan Patanol (7) syp. Polycrut fort gel (8) Nadexin Ointment (9) IVF & other supportive.”

From 31-8-2010, the patient was shifted to Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow.  The medical record of SGPGI revealed, the patient developed Stevens Johnson Syndrome after administration of Azithromycin on 27-7-2010 and thereafter since 29-7-2010, he developed jaundice.  Therefore, the patient at SGPGI was advised admission but due to non-availability of the beds, the patient was again admitted back to Bihar Institute of Gastroenterology on 1-9-2010.  Thereafter, he was treated symptomatically.  Further, the patient developed fresh erythematous rashes.  OP-2 took opinion from Dr. Sudhanshu Singh. In this context the medical record and daily nursing notes of Bihar Institute of Gastroenterology clearly show that the patient was regularly monitored during the hospitalization. The patient was suffering from exfoliative dermatis i.e. Steven Johnson’s Syndrome.  It cannot be ascertained the cause by which medicine, the patient suffered Steven Johnson Syndrome but there is clear history that prior to approaching OPs 1 and 3, patient took treatment from Dr. Shailendra Kumar and Dr. Bir Prakash Jaiswal.  Thereafter, patient was suffering from severe jaundice.  Therefore, we don’t find any role of OPs 1 to 3 in the causation of jaundice due to drug reaction.  From the medical record, it is clear that the OPs treated the patient as per prescribed guidelines and we do not find any deviation or lapses in the treatment.  The OPs investigated the patient properly and thereafter, administered the treatment of specific antibiotics, anti-histaminic and other drugs.

Observations: In the instant case, the patient approached OPs after initial treatment taken from Dr. Shailendra Kumar.  The duty of OPs was to treat the complications which were developed after previous treatment. On perusal of medical record from OP hospital, the SGPGI we do not find any deficiency in treatment aspect.  It was the standard care in the cases of SJS. The present complaint is not maintainable as the doctors whose medicines were taken between 27-7-2010 – 9-8-2010 by the complainant prior to consulting the OPs are not made a party in the present proceedings.  The medical literature on SJS/TEN suggest that the same are caused usually by antibiotics or anti-inflammatory medicines rather than PPI group of medicines.

Held: The medical professionals are duty bound to protect life. Generally, the obligation of a medical practitioner emerges from the fact that he does something to a human being which is unlikely to cause physical harm unless it is not done with proper care and skill. Negligence means and includes careless state of mind which may amount to reckless or indifference, careless conduct without reference to any duty to take care and breach of legal duty to take care. Negligence amounts to tort: (a) when there is a legal duty to exercise due care; (b) breach of the duty; and (c) available consequential damages. In the instant case the OPs 1 to 3 have treated the patient having complications like SJS/TEN. OPs have exercised their duty of care as per the standard of medical practice. We do not find any breach of duty and the consequential damage occurred in the patient due to the treatment or any deficiency of OPs 1 to 3. Therefore, we do not find any need to interfere with the well-reasoned order of the State Commission. Hence, the first appeal is dismissed.

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