KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACADU THIRUVANANTHAPURAM APPEAL NOS:253/2002 & 274/2002 JUDGMENT DATED:29.5..2009 PRESENT JUSTICE SHRI.K.R.UDAYABHANU : PRESIDENT SMT.VALSALA SARANGADHARAN : MEMBER APPEAL NO:253/2002 Dr.M.I.John, The Peoples Clinic & Hospital, : APPELLANT Pathanamthitta. (By Adv: Sri.K.Muraleedharan Nair) V. Deepa Satheesh, Kallara House, Kallarakadav, Pathanamthitta. (By Adv: Sri.Sandeep.T.George) : RESPONDENTS Dr.R. Radhakrishnan, Managing Director, The Peoples Clinic & Hospital, Pathanamthitta. APPEAL NO:274/2002 Dr.R. Radhakrishnan, Managing Director, : APPELLANT The Peoples Clinic & Hospital, Pathanamthitta. (By Adv: Sri.K.Muraleedharan Nair) V. Deepa Satheesh, Kallara House, Kallarakadav, Pathanamthitta. : RESPONDENTS Dr.M.I.John, The Peoples Clinic & Hospital, Pathanamthitta. COMMON JUDGMENT JUSTICE SHRI.K.R. UDAYABHANU : PRESIDENT The appellant in Appeal:253/02 is the 2nd opposite party and appellant in A:274/02 is the 1st opposite party/Managing Director of the Hospital. The appellants are under orders to pay a sum of Rs.10,000/- as compensation and Rs.2000/- as cost within one month from the date of receipt of the order in OP:405/00 in the file of CDRF, Pathanamthitta. 2. The case of the complainant is that on 8..11..2000 she along with her husband went to the 1st opposite party hospital for treatment of mild fever and head ache. The 2nd opposite party doctor examined her and was given an injection and some medicines. She was administered an injection and she took the medicines also. On the same day by midnight she had irritation and itching all over the body. By the next morning the situation got aggravated and the skin all over the body began to get darkened. The complainant went to the above hospital on the next day itself ie on 9..11..2000. The hospital authorities behaved in a callous and irresponsible manner and asked her to see the same doctor who treated her. It was found that the above doctor was not present in the hospital. The hospital authorities told that they cannot say when the doctor would come. As the condition was getting serious she went to the house of the doctor along with her husband. The doctor was not present in the house. The complainant then went to CovenantHospital, Mallassery where she was admitted. The condition was diagnosed as reaction to drugs. She was an inpatient at the above hospital up to 13..11..2000. On 13..11..2000 she was referred to a higher centre with more facilities. On 13..11..2000 she was taken to NSSMedicalMissionHospital, Pandalam. Her condition was so serious that initially the hospital authorities refused to admit her. Later the complainant was admitted on condition that if anything fatal happens the hospital authorities would not be liable. The husband of the complainant was required to execute a bond in that regard. She underwent various treatments at the above hospital including transfusion of 5 bottles of blood. She was an inpatient at the hospital from 13..11..2000 to 7..12..2000. The skin all over the body got darkened and there was ulcers and complete disfiguration. The same caused much mental pain and agony to the complainant and her relatives. At the time of discharge she was advised to have bed rest at least for one month and that she would need bystander for sometime. She is still undergoing out patient treatment. It was on account of the negligence on the part of the 2nd opposite party doctor and the negligence of the hospital authorities that she was subjected to such sufferings. The medicines prescribed at the hospital are not considered as medicines having the potential or history of causing reactions. The incident occurred solely due to the exchange of medicine for injection. The complainant was injected with medicine which was prescribed to be given to somebody else. She had to spend about Rs.30,000/- for medical expenses; for mental agony and pain suffered a sum of Rs.20,000/- is claimed. 3. First opposite party the proprietor/doctor of the hospital has totally denied the allegations. It is denied that the hospital authorities behaved in an irresponsible manner. The 1st opposite party hospital provides facility in General medicines, Pediatrics, Gynecology, ENT, Ophthalmology, General surgery, Dermatology etc. The allegation of exchange of medicine for injection is denied. The 2nd opposite party/doctor has filed version admitting that he had prescribed medicines to the complainant on 8..11..2000. The illness was diagnosed as URC. The following medicines were prescribed as out patient-injection:- Injection Calpol (Paracetamol), tab Nimesulide, cap Mox (Amoxicillin), tab Avil and cough syrup. 4. He gave oral instruction to stop the medicines and report immediately if any untoward reaction occurs. Afterwards the complainant never came to the 2nd opposite party. All the rest of the allegations are denied. The allegation of exchange of medicine for injection is false. He has sought for compensatory cost of Rs.10,000/-. 5. The evidence adduced consisted of the testimony of PWs 1 to 4, Exts.P1 to P9. 6.The Forum has observed that PW2 the Skin Specialist, NSS Medical Mission Hospital, Pandalam was of opinion that the accident occurred owing to negligent treatment given to the petitioner by the other hospital. The Forum concluded that the petitioner has succeeded in proving that the opposite parties have committed deficiency of service in the treatment given to the petitioner. 7. The appellants, have contented that the Forum has not considered the evidence at all. The counsel for the appellant has point out that PW2 the skin specialist have not stated in his deposition that the incident occurred owing to negligent treatment given to the petitioner by the appellants. Pw2 the doctor of CovenantHospital also has not testified anything against the appellants. It is contended that the particular illness ie Stevens Johnson Syndrome or Erythema multiforme is a disorder often of unknown aetiology (50%). It can be secondary to viral, fungal, parasitic or bacterial infection, on account of drugs, pregnancy, malignancy or communicative tissue diseases. It is also pointed out that if the cause is drug reaction the disorder would manifest after 1 to 4 weeks after exposure. As in the instant case the rashes appeared within hours of giving injection. The drug reaction alleged ought to have been ruled out. Stevens Johnson syndrome can be caused due to various reasons. There is no way to test hyper sensitivity for oral medication. Nobody can anticipate that the particular drug will produce the syndrome for the particular individual unless it is known that the patient is allergic to that particular drug it is contented. 8. PW1 the husband of the complainant has testified in terms of the averments in the complaint. He has also stated that after going to the hospital and to the house of the 2nd opposite party doctor, himself and the complainant went to the house of the doctor who is the Managing Director of the hospital. He was also not in the house. They again went to the 1st opposite party hospital but the staff behaved in an indecent manner. There after they went to the ChristianMedicalHospital but the authorities of the above hospital asked them to go to the same hospital where she had taken treatment. Thereafter they went to St.LukeHospital. The above hospital authorities also did not admit the complainant. There after they went to the CovenantHospital, Mallassery. He has stated that the above hospital is situated near to the complainant’s house and her delivery was also at the above hospital. On 13..11..2000 as advised by the doctor of the above hospital complainant was taken to NSSMedicalMissionHospital. He has also produced the treatment records of the CovenantHospital and NSSMedicalMissionHospital. She was an inpatient for one month. Costly medicines had to be administered and blood transfusion done. He also produced the photographs of the complainant at the time of treatment and bills of MedicalMissionHospital. 9. PW2 is the skin specialist of the MedicalMissionHospital has stated that at the time of admission the condition of the patient was very serious. There was high temperature and the skin was found pealed. There were rashes all over the body. Himself and the Physician examined her. It was found to be drug allergy. There was high temperature and secondary infection was suspected. He has stated that it was not a natural disease. It was drug reaction. As there was infection also the condition had aggravated. He has stated that so far he has not came to know the reaction of paracetamol injection. The onset of the reaction would depend on the capacity of resistance of the patient as well as nature of the drug. It may be sudden or may take weeks. She was administered blood transfusion and antibiotics. He has also stated that the condition was diagnosed as Steven Johnson syndrome. It can result in even cardiac problems. The secondary infection can also cause reactions. 10. PW3 the doctor of CovenantHospital has also testified as to the treatment given to the complainant at the above hospital. She has stated that at the time of admission on the 9th, the complainant was having fever, etching, rashes and ulcers in the mouth. Subsequently blood count was found decreasing. As there was no facility for blood transfusion on the 5th day she was discharged. She has stated that drug allergy can be the cause of the condition of the complainant. At the time of admission the complainant was not having any records of previous treatment. The complainant was also examined by the Physician and the Dermatologist. 11. Ext.P4 is the photograph took the photographs of the complainant. The same are produced with the negatives. The photographs were taken when the complainant was under treatment at the MedicalMissionHospital, Pandalam. We find that the photographs and the evidence of PWs 1 to 3 the complainant and the doctors would show that there was disfigurating rashes/ulcers on face, hands etc. The evidence of PW1 the complainant and PW2 and PW3 the doctors prove convincingly that the condition of the complainant was serious. Blood count had gone down and blood transfusion had to be given. In Ext.P3 the certificate of CovenantHospital it is mentioned that she was referred to a higher centre for specific treatment and blood transfusion. It is also mentioned therein that she was treated in consultation with the Dermatologist and Physician. In Ext.P4 certificate of the MedicalMissionHospital it is mentioned that the illness was due to secondary drug allergy. In the discharge certificate of CovenantHospital the condition of the patient at the time of admission is mentioned as occurred after intake of medicines from another hospital which are mentioned as Cap Mox, tab Nise, tab Avil etc. The medicines administered etc and the result of blood count is also mentioned. Ext.P2 is the OP card dated:8..11.2000 of the 1st opposite party hospital. No prescription was produced. 12. The opposite parties have not adduced any evidence. Although it is mentioned in the version of the 2nd opposite party doctor that injection calpol, tab Nimesulide tab Mox and tab Avil and cough syrup was prescribed. No documents in this regard have been produced. As already noted the 2nd opposite party has also not deposed. The 1st opposite party hospital said to be having various departments of medicines should have kept the records of treatment prescribed to the patients whether out patient or inpatient. No reason is mentioned for not producing the above documents. If such documents are not kept in the hospital it cannot be said that hospital is functioning in a normal and expected manner. 13. The documents produced with respect to the treatment at Covenant Hospital and NSS Medical Mission Hospital and the evidence of PWs 2 and 3 doctors prove that the complainant suffered from Erythema multiforme major (Stevens Johnson syndrome) which can even be fatal and cosmetically much damaging especially as the complainant is a young woman. Both PWs 2 and 3 has mentioned that it was drug reaction. It is a reaction pattern particularly to certain individuals. It is a most severe mucosal skin disease characterized by signs and symptoms remniscent of serum sickness. Reaction to certain drugs like Sulphonamides, penicillins, barbiturates, carbamazepine, Phenytoin and non steroidal anti inflammatory drugs (NSAIDs) are the most common drugs implicated in Stevens Johnson syndrome and toxic, epidermal, necrolysis, (Cecil, Text Book of Medicine, Volume II p 2471). Any agent involving the particular drug group ie Sulphonamites, NSAIDs, Anti convulsants, such as phenytoin should be considered a potential offender (Current Medical Diagnosis and Treatment-2006 edited by Lawrance.M.Tierney Jr etc. pp 122, 123). The presence of blisters is prominent in cases of Stevens Johnson syndrome. Although the 2nd opposite party doctor has mentioned in the version that it was paracetamol injection. Tab Nimesulide and cap Mox, tab Avil and cough syrup that was administered the opposite parties have not produced the relevant records. It is pertinent to note that PW1 has deposed that the complainant was taken to two other hospitals who did not agree to treat her and directed him to take her to the same hospital where the treatment was given earlier. As to how the 2nd opposite party recollected the details of medicines prescribed to the complainant is not evident. If there were records of the drug that was injected the same ought to have been produced. There is nothing to show that the hospitals that treated the complainant were aware of the nature of the drug that was injected on the complainant. The same would have helped in the treatment of the complainant. Evidence adduced would show that the complainant was in a serious state of affairs. The attitude of the staff of the opposite party hospital as testified to by PW1 and has mentioned in the complaint is really unhelpful. It is the case of the complainant that she was taken to the residence of the 2nd opposite party and also to that of the 1st opposite party doctor/Managing Director of the hospital. 14. In the decisions produced of this Commission ie Miss.Geetha Kumari V. Dr.Mrs.Anitha Rajan 1995 II CPR 393 and Cherothe Suhara V. Dr.K.K.Subramoniam and Another 1995 (1) CPR 258 are not relevant in view of the facts of the instant case. Davidson’s Principles and Practice of Medicine (17th Edition page 973) cited by the counsel for appellants only mentions about the nature of Stevens Johnson syndrome and its precipitant factors. In the instant case it was drug reaction stands established. The attitude of the opposite parties in not keeping the records of treatment or not producing the same before the Forum and not volunteering to treat the complainant when she desperately reached the hospital on the manifestation of the drug reaction we find amounts to deficiency in service. In the circumstances we find that the order of the Forum does not call for interference. The order of the Forum is confirmed. Both the appeals are dismissed. JUSTICE K.R. UDAYABHANU : PRESIDENT VALSALA SARANGADHARAN : MEMBER VL.
......................JUSTICE SHRI.K.R.UDAYABHANU
......................SMT.VALSALA SARNGADHARAN | | 
