Complainant/appellant’s son was admitted in the respondent hospital on 20.8.1997 as he had consumed Organophosphate liquid being disappointed with his result of Junior Intermediate Examination.  Opposite party No.2, Dr.J. Raghunath, examined him, washed his stomach, administered Atropine intravenously, shifted the boy to ICCU and left the hospital.  After some time the boy complained of breathlessness, his body was turning blue and became unconscious.  The doctor came with anaesthetist and gave electric shock to revive the heart but the respiratory system did not revive.  The patient went into COMA.  It was alleged that if Respondent No.1 had remained in the hospital, the mishap could have been prevented.  It was also alleged that there was power failure in the night, due to which artificial respiration was given with the help of ambubag.  Certain other allegations of similar nature were also made.  Aggrieved by this, appellant filed a complaint before the State Commission claiming Rs.18,50,000/- along with costs of Rs.10,000/-.

          State Commission dismissed the complaint holding that the deceased had consumed Endrin, a toxic organochlorine pesticide and there was a gap of more than 4 hours between consumption of the pesticide and bringing the patient to the hospital, which was sufficient for the poison to enter into the vital organs of the body which resulted into breakdown of the Central Nervous System.  That there was no deficiency in service or medical negligence on the part of respondents.  State Commission observed as under :

“From what is stated above it is difficult to isolate reasons for breakdown of central nervous system in such cases and the patient may go into coma.  Treatment and the attention paid bythe opposite parties as revealed from the case sheet Ex.B-1, we cannot hold any negligence on their part.  As there is time lag of more than 4 hours i.e. between 9.00 PM to 1.00 AM which is sufficiently long time for the poison to enter into the vital organs of the body and unfortunately this might have happened in this case and the boy could not be revived.  The hospital atropin chart, intake out put record, shows the treatment and the constant whistle and attention paid to the patient.  Hence we are unable to hold that there is any deficiency in service on the part of the opposite parties.”

          Against the order passed by the State Commission, present appeal has been filed.  During the pendency of the appeal on 26.8.2009, this Commission passed an agreed order to obtain the opinion from expert from AIIMS.  Order dated 26.8.2009 reads as under :

“After hearing the counsel for the parties at some length, it is noticed that the complainant produced and examined one witness, namely, Dr. B.Rama Mohan Rao, an Intensive Care Physician and Anaesthesiologist, who happened to be the maternal uncle of the deceased patient Venkat Sai Krishna, as well as the affidavit of one Dr. B.Bharathi Lakshmi in support of their contention.  The respondents also filed the affidavit of a doctor.  To settle the controversy we consider it desirable to have independent expert opinion as to whether there was any negligence in providing treatment to Venkata Sai Krishna at any stage, particularly the period of 1 a.m. to 4 a.m. of 20.8.1997 according to the standard medical practice in such a situation.  Learned counsel for the parties have no objection to this.  Accordingly, we request the Director, All India Institute of Medical Science (AIIMS), New Delhi to constitute a Medical Board of senior doctors in the disciplines of intensive care as well as toxicology so as to give their opinion, with their reasons, in the matter, after going through the medical records produced by the parties.

Parties are directed to prepare a compilation of the entire medical record including the opinion of the expert witnesses produced by the parties and to submit the same to the Registry within two weeks.  On doing so, the Registrar shall address a suitable communication to the Medical Superintendent of the AIIMS enclosing a copy of the compilation of the medical record for taking necessary action and send the report of the Medical Board to this Commission by 15^th October 2009.”

          Matter was accordingly referred to AIIMS, which has given its opinion.  Experts have submitted their report, copy of which was supplied to the counsel for the appellant as well as the respondent  on 21.1.2010 with a direction to file brief note of submissions in regard to the report not running into more than 3 pages along with the medical literature.  AIIMS has endorsed what has been stated by the State Commission in its order.  The experts have also stated that by the time the patient reached the hospital, approx. 3 hours had already elapsed, which was sufficient time for the toxin to get absorbed in the systemic circulation and produce toxic effects.  Counsel for the petitioner has not filed either the submission note or the medical literature.  The report submitted by the Medical Board, which was constituted of 4 doctors, reads as under :

“A medical board was constituted by the Medical Superintendent, AIIMS on subject noted above.  The Board consists of the following Members:

1.      Dr. Uma Kumar                                                        -  Chairman

          Assoc. Professor, Deptt. Of Medicine

2.      Dr. D. Bhowmik                                                    -  Member

          Assoc. Professor, Deptt. Of Nephtology

3.      Dr. DArlong V.                                                 -  Member

          Asstt. Professor, Depatt. Of Anaesthesiology

4.      Dr. Shikha Singh                                                         -   Member Secy.

The second meeting of the medical board was held on Monday 18^th January, 2010 at 02:30 P.M. in Room NO.13, VIP Consultation Room, M. S. Office Wing, AIIMS.  All the members of the board were present.  After thoroughly reviewing the provided medical records, board made following observations:

1.    Endrin is a toxic organochlorine pesticide which can cause death of the patient within few hours, if consumed in large quantity.  Ingestion of Endrin primarily causes central nervous system toxicity, but nonspecific degeneration of kidneys and liver is also reported.  Acute toxicity with Endrin may result in pulmonary oedema.  Treatment of acute intoxication remains supportive.

2.    By the time patient reached hospital approximately 3 hours have already elapsed, which is sufficient time for the toxin to get absorbed into the systemic circulation and produce toxic effects.

3.    Details of following are not mentioned

(1)   Amount of pesticide consumed

(2)   Patient monitoring records from 1 am to 4 am on 20/08/1997.  

Therefore, board is unable to form any opinion regarding appropriateness and adequacy of treatment given from 1 am to 4 am on 20/01/1997 which was the most crucial time.

4.  Board is unable to comment on qualification of nursing staff and doctor on duty as no relevant details are provided (degree, experience certificate etc.)

5.    As far as resuscitation and endotracheal intubation is concerned, any qualified registered medical practitioner should be able to do it.

6.  The patient had normal renal function at the time of admission.  He developed pre renal azotemia subsequently.  The renal function terminally was not dialysis requiring, which could have been managed by internist.  Given his renal function presence of nephrologists would not have made any difference to patient’s condition.”                               (emphasis supplied)

          In view of the report submitted by the experts from AIIMS, we endorse the finding recorded by the State Commission.  Appellant has failed to prove either negligence or deficiency in service by the respondents.  Dismissed.