BEFORE THE DISTRICT FORUM:KURNOOL
Present: Sri.K.V.H. Prasad, B.A., LL.B President
And
Smt. C.Preethi, M.A.LL.B., Lady Member
Monday the 09th day of February , 2009.
C.C.No. 45/08
Between:
G. Mariyamma,
W/o. Late G.Devadas,
H.No.51-1026 F1,
LIC Colony,
Kurnool. … Complainant
Versus
Dr. P. Rajasekhar,
(MD) General,
Assistant Professor of Medicine,
Government General Hospital,
Kurnool. … Opposite party
This complaint is coming on this day for orders in the presence of Sri. G. Naga Bhushanam, Advocate, for the complainant, and Sri. D. Srinivasulu, Advocate, for the opposite party and upon perusing the material papers on record, the Forum made the following.
ORDER
(As per Sri. K.V.H.Prasad, President)
C.C.No.45/08
1. This case of the complainant is filed U/S 11 and 12 of C.P.Act seeking direction on the opposite party to pay her Rs.1 lakh as compensation for mental agony and hardship , Rs.50,000/- towards the subsequent and future treatment and cost of the case alleging negligency and deficiency of the opposite party in rendering medical service to her when she approached the opposite party on 01-02-2006 at 9-30 p.m with a complaint of burning sensation in the stomach due to acidity , as prescribed Prazopress XL 2.5 mg along with Cyra 20 mg without holding any diagnostic test such as ECG , Echo Gradiography, TMTL when B.P recorded was 180/100 and without minding for its possible adverse effect in its first use and the age factor of the complainant and on account of its use the complainant fell unconscious with the symptoms faintness , stipness and dry mouth etc on 02-02-2006 and was made to join Gowri Gopal Hospital and Government General Hospital , Kurnool for necessary further treatment and incurred an expenditure of Rs.5,000/- at each hospital and even then not relieved of sufferings giddiness , weakness inability to walk , dry mouth blurred vision etc., and this was on account of the opposite party negligent prescription of heavy dose of Prazopress XL 2.5 mg without minding to the age and nature and other factors of the complainant.
2. In pursuance of the receipt of the notice of this forum as to this case of the complainant , the opposite party has caused its appearance through his counsel and contested the case filling written version denying any of his liability to the complainants claim and seeking dismissal of the complaint with cost.
3. The written version of the opposite party even though admits the approach of the complainant to him with complaint of Epi Gastric discomfort i.e., burning sensation in stomach and headache and use of Ofloxine and Omidazole combination tablet and on checking her blood pleasure as 180/100 and on clinical examination her cardio vascular system and heartbeat and respiring system as normal and learnt from the complainant that she was hypertensive and using medicine for that since last few years and the Prazopress XL 2.5 mg is not a heavy dose and to the complaint of the complainant the test alleged by the complainant are not necessary and the subsequent complaints of the complainants were neither due to low B.P nor the said patient are anything to do with the medicine prescribed by him nonetheless with Prazopress XL 2.5 mg and her complications may be due to old age as in the treatment given to complainant at Gowri Gopal Hospital was for “ Transient Isheamic Attack” (TIA) – a neurological problem and treatment in Government General Hospital, kurnool was “ Benign Positional Vertigo” with Hypertension and Cervical Spondylitis , which could be related to the old age and the complainant was a known hypertension patient and this complaint is filed to have a wrongful gain from the opposite party and there being any negligence in rendering treatment to the complainant , the opposite party is not liable to the complainants claim.
4. In substantiation of the contentions while the complainant side has taken reliance on documentary record in Ex.A1 to A12 , Ex.X1 and the evidence of PW.1 Dr. Mohammad Ghouse besides to her sworn affidavit , the opposite party side has taken reliance on the evidence of himself and that of Dr.T.Dhan Raj (RW.2).
5. Hence, the point for consideration is whether there was any medical negligence on the part of the opposite party in rendering treatment to the complainant and for the subsequent suffering of the complainant was anything to do it the use of the prescription given by the opposite party and there by any liability of the opposite party to the complainants claim .
6. The contention of the complainant is that her health become questionable with other problems consequent to the use of the Prazopress XL 2.5 mg prescribed by the opposite party on her approach with the complaint of burning sensation in stomach . Consequent to use of said medicine prescribed by the opposite party , the complainant as falling as unconscious was constrained to be taken for treatment to Gowri Gopal Hospital and from there to Government General Hospital , kurnool for further complications she faced and even after said treatment she was not well and so requiring further treatment . It is also further contended that when for B.P was recorded as 180/100 at the time of the opposite party prescribing the medicine the opposite party without conducting the required test made such prescriptions of medicine which has lead to further compilations to her. Hence it is requiring for appreciation of the material in support of her contentions as the contentions of the opposite party is that the medicine prescribed by her to the complainant is nothing to do with the further alleged complications of the complainant for which she has undergone treatment at Gowri Gopal Hospital , Government General Hospital , Kurnool subsequently .
7. As per the information literature of manufacturer of Prozapress XL 2.5 mg , it is composition of Prozasin Hydrochloride IP equalent to Prozasin 2.5 mg or 5 mg .
8. Under chapter No. 3 – factors modifying drug effects at Page No. 55 authored by R.S. Satosar – it is stated that “ Old people also present problems in dosage adjustment and this may vary widely with different people . The Heptaic Blood flow and Metabolism of drugs may diminish in the elderly and the renal functions declines with age . Elderly patients are more sensitive to some drug effects ”.
9. The same author under chapter No. 29 – hypertension – drug therapy at page 24 says as to classification of hypertension as under
Table 29.3: Classification of hypertension
Category Systolic BP Diastolic BP Recommendation
(mm.Hg) (mm.Hg)
Normal <120 and <80 Recheck in 2 years
High Normal 120-139 or 80-89 Recheck in 6 months
Hypertension
Mild 140-159 or 90-99 Confirm & treat
within 2 months
Moderate 160-179 or 100-109 Treat within 1
Month
Severe 180-209 or 110-119 Treat within 1 weak
Very severe 180-209 or 110-119 Treat immediately
It recommends for hypertension of normal , high normal , mild , moderate , severe and very severe the recheck in two years , recheck in six months confirm and treat within two months , treatment within one month treatment within one weak and treatment immediately respectively .
10. As the B.P of the complainant observed by the opposite party on her approach for treatment was 180/100 . As per the evidence of opposite party (R.w.1) the said state of hypertension was severe hypertension being at stage 3 and as per the above stated norms as to assess the stage of hypertension it has to be treated immediately .
11. As per the same author in the chapter Pharmaco Therapy of hypertension relating to hypertension in the elderly at Page No. 426 it is stated that “ in patient over 70 years of age treatment should be considered whose B.P exceeds 140/85 mm Hg . Rapid lowering of B.P and postural hypertension can be dangerous and ….. Clomidine and Prazosin are also better avoided because of their possible adverse effect . Complex, multiple drug regimes are best avoided in the elderly as they may be confusing and a patient with an established stroke in old age does not benefit from such therapy and infact some patients of said group may show an intellectual deterioration on lowering of the B.P . The aim of therapy in the elderly should be to lower the B.P as much below 180/100 mm Hg as the patient can tolerate comfortably preferably to 160/85 mm Hg or less and no attempt should be made to make the B.P normal ”.
11. As the B.P of the complainant recorded , on joining the Gowri Gopal Hospital consequent to ill effects on use of the medicine prescribed by opposite party , was 100/60 , the opposite party appears to have not acted reasonably in prescribing the medicine Prazopress XL 2.5 mg and perhaps not visualized the possible adverse effects of said medicine at the time of prescribing the said medicine to the complainant to meet the hypertension complaint of the complainant , nor appears to have cautioned the complainant of the possible adverse effects of the prescribed medicine .
12. The same author in chapter 29 – Adrenergic Receptor Blockers at page No. 411 dealing with adverse reactions of Prazosin states giddiness , drowsiness , tiredness , weakness , nausea , diarrhea , fluid retention , papilation and nervousness and the first dosage should be 0.5 mg or less and should be taken on retiring to bed at night , as some patients have adverse reactions of even collapse and loss of consciousness besides to the above following the first dose . As the medicine prescribed for use of the complainant being Prazopress XL 2.5 mg and not the minimum dose of 0.5 mg and anti hypertensive drug should be started with small dose and the complainant as fell unconscious on use of said medicine and was constrained to join Gowri Gopal Hospital – the opposite party appears to have negligently prescribed the above medicine to the complainant unmindful of medical norms and its possible consequences on the complainant .
13. The principles of Devi Dasu’s medicine at page No. 391 prescribes investigations of Urine analysis for blood , protein , glucose , blood urea , electrolytes , and creantine , blood glucose , serum total Hydensity Lipo Protein ( HDL), cholesterol , 12 lead ECG in case of all hypertensive patients and in selected patients for hypertension Chest Radiograph – to detect Cardio Megaly , Heart failure , Coarctation of the Aorta , Ambulatory B.P recording – to assess border line or “ white coat” hypertension , Echocardiogram – to detect or quantify left ventricular hypertrophy , Renal ultrasound – to detect possible renal decease , Renal Angiography – to detect or confirm presence of renal artery stenosis , Urinary Cate Cholamines - to detect possible Phaeochromocytoma , Urinary Cortisol and Dexamethasone suppression test – to detect possible Cushing’s Syndrome , Plasama Renin activity and Aldossterone – to detect possible primary Aldosteroniasm .
14. But the opposite party appears to have not got any such test to assess the complaint of the complainant merely satisfying himself of some clinical test on the complainant . Hence the opposite party appears to have not acted as a prudent doctor in compliance of medical norms in assessing the complaint of the complainant before prescribing the medicine to the complainant for her reported complaint .
15. The Hon’ble Chattisgarh State Consumer Disputes Redressal
Commission at Raipur in Sandeep Agarwal and others Vs Modern Medical Institute and others reported in II ( 2005) CPJ Pg . 601 holds the gross negligency on the part of the doctor who prescribes the treatment without investigations and diagnosis and will be under obligation to explain possible side effects before starting treatment to any patient .
16. In the present case there is any such cogent material from the opposite party side as to any investigation prescribed under medical norms and diagnosis of the complaint of the complainant , nor his explaining of any possible side effects of the medicine prescribed to the complainant . Hence the opposite party is remaining of medical negligency in rendering medical service to the complainant and there by holds his liability for said deficiency for the consequential suffering of the complainant .
17. The evidence of PW.1 Mohammad Ghouse , who treated the complainant in Gowri Gopal Hospital , Kurnool , says that when a patient comes the systems will be observed taking into account earlier medical history and thereafter clinical examination will be done and if any suspicion arises in clinical examination then only other further test will be conducted . As no authority in support of said contention of the witness as has been filed it is not remaining worthy of consideration to come across the mandatory test prescribed for any patient of hypertension as stated in earlier paras .
18. In the same way the PW.1 states generally that in severe hypertension stage the patient will be administered additional drugs in addition to the drugs already been used by said patient to bring down the B.P and so the use of additional drug will be as adjuctive drug . Whether the opposite party prescribed Prazopress XL 2.5 mg as additional drug or a mere drug is not the controversy in point as the opposite party is negligent of observing mandatory medical norms and visualizing probable adverse effects of the said drug taking into account the age factor of the complainant who is said to be of 70 years old . Hence the said evidence of PW.1 remains of any help to the case of the opposite party and for believing any bonafidess of the opposite party in the medical services rendered by him to the complainant .
20. The evidence of PW.1 further remains unworthy of consideration as he says the staring dose of Prazopress XL 2.5 mg while stated in earlier paras the prescribed starting dose should not exceed .5 mg and as no supportive authority is placed in support of the said contentions of the PW.1 . In the light of the unsubstantiated contentions it appears of the evidence of PW.1 is an interested one in saving the opposite party because the opposite party also belongs to same profession .
21. The PW.1 even though attributes the complaint of complainant falling unconscious consequent to use of the medicines prescribed by the opposite party as Neurological Discomfort on account of narrowal of arteries and meager supply of blood through arteries and it will be on account of her age , hyblood pleasure and Cardiac dysfunction giving a medical name as “ Transitent Ischaemic Attack” . But there being any such complaint to the complainant earlier to then and the said being only a suspicion , the said attribution to the complainants further complaint is not remaining beyond the suspicion of the use of prescribed medicine by the complainant which is having some possible side effects one among which is becoming unconscious and at times collapsing also .
22. The RW.2 Dr. T.Dhana Raj who rendered subsequent treatment in Government General Hospital , Kurnool also even though says the complaint of the complainant was on account of insufficient supply of blood to the brain and the dosage of Prazopress XL 2.5 mg prescribed is not an excess dosage but in the absence of any such earlier complaint with the complainant and as any supportable authority being placed in support of RW.2 s contentions , his evidence remains to be nothing but an interested one in the opposite party in those aspects being latter also of his profession .
23. The evidence of RW.2 as says that there is possibility even after 10 hours after to administration of Prazopress XL 2.5 mg tablet for postural hypertension in few cases and the doctor is expected to visualize not generalities but only exceptions which endangers the life , the opposite party appears to be deficient and negligent in prescribing the medicine without proper investigations and diagnosis and visualsing the possible adverse and cautioning of them well in advance to the complainant.
25. The opposite party in his evidence as RW.1 says that the complainant did not name out the medicines she was using hither to for hypertension except saying as using medicines and says if the prescribed medicines dose is excess it will cause postural hypertension effects such as falling unconscious , dryness of the mouth, papilation ( increased heart beat) pinnitus ( ringing in ears) etc., as the complainant falling unconscious consequent to use of the medicines prescribed by the opposite party it goes without any say undoubtedly and the said subsequent complication of the complainant , which constrained her to resort for further medical treatment in Gowri Gopal Hospital, and Government General Hospital , Kurnool vide Ex.A1 , A10 , A11 and Ex.X1 was nothing but on account of administration of excess dosage of medicine by the opposite party to the complaint of the complainant .
26. When the Ex.A1 indicates the line of treatment the complainant has undergone at Gowri Gopal Hospital, after having suffered the side effects of excess dosage of the medicines prescribed by the opposite party under Ex.A6, the material in Ex.A2 to A5 indicates the diagnosis test the complainant has undergone in subsequent treatment and the Ex.A7 to A9 indicates the incurred expenditure of the complainant in purchasing the prescribed medicines in further treatment . There is any material contradicting the bonafidess of said material to disentitle the reimbursement of its value to the complainant .
27. The reluctant conduct of the opposite party besides to his deficiency in rendering medical services to the complainant is further appearing in his conduct of not responding to the notice of the complainant in Ex.A2 setting forth her grievances which he would have replied if there were any bonafidess and frudencies in the treatment he rendered to the complainant .
28. While the incurred expenditure for diagnostic charges vide Ex.A7 bunch of diagnostic charges receipts totals Rs. 2,940/- the incurred expenditure of complainant for purchase of medicines vide Ex.A8 bunch of 9 bills and Ex.A9 bunch of 6 bills totals to Rs.2,113.98 ( i.e, Rs.1697.32 + Rs.416.66) thus the total medical expenditure incurred by the complainant towards diagnostic charges and medicines purchased totals to Rs.5,053.98 ( Rs.2,490- + Rs.2,113.98) while the complaint alleges the incurred medical expenditure as Rs.5,000/- which is near by to the total of Ex.A7 to A9 . As the said expenditure incurred by the complainant being subsequent to the ill effects of the medicines prescribed by the opposite party , the complainant is remaining entitled to said actual incurred medical expenditure of Rs. 5,054/- at the liability of the opposite party .
29. As the complainant was put to further treatment at the negligent prescription of the medicine by the opposite party and not responding to the demand notice of the complainant not only caused mental agony to the complainant but also driven her to the forum for redressal of her grievances , the liability of the opposite party remains to make good of to the complainant , in the circumstances of the case , an amount of Rs.50,000/- as compensation for mental agony and Rs.10,000/- as cost of the case besides to the actual incurred medical expenditure of Rs.5,054/- .
30. Therefore the complaint is allowed directing the opposite party to pay to the complainant , for his negligence and deficiency in rendering medical service to the complainant , Rs.50,000/- as compensation for mental agony , Rs.10,000/- as cost of this case and Rs.5,054/- towards actual incurred medical expenditure in further treatment , within a month of receipt of this order. In default the supra stated award shall be payable by the opposite party to the complainant with 12% interest from the date of default till realization.
Dictated to the stenographer, transcribed by her, corrected and pronounced by us in the open bench on this the 09th day of February 2009.
Sd/- Sd/-
MEMBER PRESIDENT
APPENDIX OF EVIDENCE
Witnesses Examined
For the complainant : For the opposite parties :
PW.1. Deposition of PW-1 dated RW.1 Deposition of RW.1 dated
17-07-2008( Dr. Md.Gouse, M.D) 07-08-2008 (Dr.P.Rajasekhar)
RW.2. Deposition o RW.2 dated 09-09-2008 (Dr.T.Dhanraj)
List of exhibits marked for the complainant:-
Ex.A1. Case sheet G. Mariyamma of Gowri Gopal Hospital , Kurnool , Page No. 15.
Ex.A2. C.T.Scan report.
Ex.A3. Randum blood sugar report.
Ex.A4. Hemoglobin serum creatinine report.
Ex.A5. Echo ( 2D Echocardiography) report.
Ex.A6. Prescription of Sri Dhanalaxmi Medical stroes ,Kurnool
Dated 01-02-2006.
Ex.A7. A bunch of 5 receipts issued by Gowri Gopal Hospital, Kurnool.
Ex.A8. A bunch of 9 bills as to the purchase of medicines.
Ex.A9. A bill of 6 bills for amounts received from complainant by Sri. Eswar , Agencies.
Ex.A10. Discharge card issued by Gowri Gopal Hospital, Kurnool.
Ex.A11. Discharge/ summary card issued by Gowri Gopal Hospital ,
Kurnool.
Ex.A12. Office copy of legal notice dated 22-01-2008 issued to OP along with acknowledgement.
Ex.X1. Case sheet of G.Mariyamma issued by Government General Hospital , kurnool.
List of exhibits marked for the opposite parties: Nil
. Sd/- Sd/-
MEMBER PRESIDENT
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A.P.S.C.D.R.C. Rules, 1987//
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Complainant and Opposite parties
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