ORDER

5.       We have heard the arguments from both the sides and perused the Medical Record inter alia two expert opinions. The case of the Complainant is that due to complications developed because of overdose of sedatives and anti-psychotic, the patient died. Whereas the case of the Opposite Parties is that during hospitalization, the patient was treated for the psychiatric problems as per reasonable care. The death was due to cardiac arrest but not due to complications of drugs or over dosage.  

6.       In the instant case, the State Commission took an opinion from the Medical Board constituted at PGI, Chandigarh. The Board consists of the Specialist doctors from Department of Psychiatry, Internal Medicine, Cardiology and Hospital Administration. The Board gave the opinion on following 3 specific points as under:-

1.         Whether the protocol was observed by OPs in respect of dose given to the deceased while treating him as a patient of psychiatry.

2.         If there was over dose whether the same resulted into complication resulting in the death of deceased.

3.         Whether the requisite treatment was given to the patient after his condition became serious at 7 PM on 04.02.2010.

The board opined as :

"1. On the basis of the available record, it is evident that the patient (Late Shri Sanchit Khosia, 41 years old male) was suffering from a serious mental illness, most likely schizophrenia, for 11-12 years, and was admitted with frank psychotic symptoms, aggressive behviour and behavioral disinhibition. Sepcific psychotropic medicines given to the patient, which include antipsychotics and sedatives as part of the treatment package, are required for treatment of such patient as per present medical standards.

2. As per the available record, patient Late Shri Sanchit Khosia was suffering from multiple medical conditions such as uncontrolled Diabetes Mellitus, Obesity, and probable Obstructive Sleep Apnea, all of which are known medical risk factors for occurrence of adverse cardiac events. Use of antipsychotics and sedatives (which was a requisite treatment for his uncontrolled and severe psychiatric problems at the time of admission) can precipitate acute Cardio-Pulmonary events in such high-risk patients. The doses of the antipsychotics and sedatives, as recorded in the Treatment Charts provided to the Board for scrutiny, are within approved ranges for the drugs used in such conditions and hence cannot be said to constitute an "overdose" as such. On the basis of available record it is not possible for the Board to infer or comment on the question whether these doses of the medications used have resulted in complications leading to his death.

3. On the basis of available record the condition of the patient suddenly and rapidly deteriorated on 04.02.2012 from 7.00 PM onwards, and thereafter he appeared to have received reasonable care and treatment as per the existing treatment protocols."

7.       Before the State Commission, the Complainant in her support, filed an affidavit with opinion of Dr. Vishwas Madhav Thakur, a private practicing Physician at Gurgaon that there was negligence during treatment of the patient at the Opposite Party No. 1 hospital. According to him, Dr. Rupesh Chaudhary, the senior Consultant in Psychiatry department advised a cocktail of 6 medications (2 hypnotics and 4 antipsychotics) in the casualty itself. The 4 Antipsychotics were Injection Serenace (Haloperidol 5 mg), Injection Clopixol 100 mg, Tab Sizopin (Clozapine) 25 mg, Tab Sizodon Plus (respirodone). The two hypnotics drugs are Inj Lorazepam 4mg and Midazolam 5 mg. According to him, the diagnosis of schizophrenia and Obstructive Sleep Apnoea were without any supportive investigations. The patient never recovered, but developed serious complications like severe respiratory depression and hypoxia of the brain and finally, expired due to Cardio-Pulmonary arrest.  He further opined that the treatment adopted in OP-1 hospital and maintenance of hospital record was not as per standards. Most of the pages of the clinical notes appear a retrospective makeover of the records.

8.       We have gone through the standard medical text books on medicine and Neurology, Psychiatry viz. Harrison’s Internal Medicine and Oxford Textbook of Neurology. We have also gone through the medical literature filed by the learned Counsel for the Appellant. In our opinion the treatment given to the patient was as per prescribed standards. It is apparent from the past medical history, that in year 2002, the patient was admitted in mental hospital at Amritsar. Again in year 2003, he was shifted to one private hospital and also in PGI Chandigarh. As per ICD-10 criteria, he was diagnosed as "Schizophrenic-Paranoid type with type II DM with severe family, personal, social and occupational dysfunction. Patient   ran away from PGI during treatment. Moreover, it is pertinent to note that Dr. Thakur was not a subject expert in Neuroscience or Psychiatry. Therefore, we do not give more credence to his opinion than the opinion of Board’s subject experts at PGI, Chandigarh. The PGI experts opined that there was no negligence and the doses of anti-psychotic and sedative drugs were within normal range, it was not an overdose. On 04.02.2012, from 7pm, suddenly the condition of the patient rapidly deteriorated and he was treated as per existing CPR protocols.

9.       We would like to rely upon the precedents of the Hon’ble Supreme Court, which laid down standard principles to establish medical negligence in the cases of Jacob Mathew v. State of Punjab[1] and Kusum Sharma & Ors. V. Batra Hospital and Medical Research Centre & Ors.^[2]. Regarding the mode of treatment in the case of Achutrao Haribhao Khodwa & Others V State of Maharashtra & Others^[3], the Hon’ble Supreme Court held that:

“in the very nature of medical profession, skills differs from doctor to doctor and more than one alternative course of treatment are available, all admissible. Negligence cannot be attributed to a doctor so long as he is performing his duties to the best of his ability and with due care and caution. Merely because the doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chosen by him was acceptable to the medical profession.”

10.     Based on the forgoing discussion we do not find any negligence or deficiency in service on part of the Opposite Parties. There was no deviation from the standard of practice. The doctors treated the patient as per the clinical signs of the psychiatric disease. The prescribed dose of medicines was well within the acceptable range. Thus, in our considered view, the patient did not suffer from the overdose of such medicine. However, during treatment, the patient suffered cardiac arrest, which caused his death. 

11.     The Order of the State Commission is well-reasoned, which needs no interference. The First Appeal is dismissed. There shall be no order as to costs.

We thank the Amicus Curie for his services and assistance to the bench.