DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, PALAKKAD

Dated this the 31^st day of August 2011

Present : Smt.Seena.H. President

:Smt. Preetha G Nair, Member

: Smt.Bhanumathi.A.K. Member Date of filing: 19/01/2007

(C.C.No.3/2007)

1.John Felix Thangaraj,

Chinna Maniankara House,

Pambuparai, Chandrapuram,

Valayar (PO), Palakkad.

(By Adv.R.Gangadharan &

Adv.P.R.Rameshkumar)

2.Jancy Mary,

D/o.John Felix Thangaraj,

3. Jacintha Mary,

S/o.John Felix Thangaraj,

4. Samson Raj,

S/o.John Felix Thangaraj, - Complainants

V/s

1. Dr.P.L.Shaju,

Unity Hospital,

Chittur Road, Kozhinjampara,

Palakkad – 678 55.

(By Adv.K.P.Ramadasan)

2. Administrative Officer,

Unity Hospital,

Chittur Road, Kozhinjampara,

Palakkad – 678 55.

(By Adv.K.P.Ramadasan)

3. The Administrative Officer,

Jubilee Mission,

Medical College Hospital,

and Research Centre,

Thrissur – 5

(By Adv.Anto Davis & Jayachandran G)

4. The Oriental Insurance Co.Ltd.

Shobha, TSM Complex,

Opp.Town Railway station,

Palakkad.

(By Adv.P.Ramachandran)

5. The United Insurance Co.Ltd.

G.B.Road, Palakkad.

(By Adv.Lakshminarayanan) - Opposite parties

O R D E R

By Smt.SEENA.H. PRESIDENT

The complaint in brief :

Complainants are the legal heirs of deceased Roslin who is the wife of the 1^st complainant. The wife of 1^st complainant who caught fever was taken to the 2^nd opposite party hospital and was treated by the 1^st opposite party. Patient was admitted on 18/11/2005. Opposite parties made laboratory tests on 19/11/2005 and ultra sonography was done on 20/11/2005. Thereafter an injection was administered on the patient on 20/11/2005. Within 5 minutes after the administration of the injection the body of the patient started to discolour. Urine colour also got changed. Jaws and gums also got discoloured. Blisters and boils started appearing on the skin and the skin came off peeling when touched. Patient complained burning sensation in her mouth, throat and stomach. The daughter of the patient alerted the nurse about the discolouration. The complainant believes that the discolouration and decomposition of the skin was due to the injection administered on 20/11/05 by opposite parties 1 & 2. Further the injection was administered without any test dose application. Though the critical situation warranted immediate competent medical attention, opposite parties 1 & 2 did not shift the patient to any other competent and well equipped hospital. Opposite parties 1 & 2 detained the patient on the flimsy ground of settlement of bills which was actually paid. Opposite parties shifted the patient to 3^rd opposite party hospital only on 22/11/05. According to the complainant, opposite party 1 & 2 did not treat the wife of the complainant with due care expected of a medical practitioner and she succumbed to the negligent and reckless incompetent treatment given by them. The opposite parties 1 & 2 did not exercised the standard of prudence and skill expected of a medical practitioner before administering the injection. The patient died at the 3^rd opposite party hospital on 25/11/2005. Complainant spent an amount of Rs.2861/- at the 2^nd opposite party hospital and Rs.9476/- at the 3^rd opposite party hospital. Complainants alongwith the said amount claims Rs.5 lakhs as compensation. Hence opposite party 1 & 2 are liable to compensate the complainant. 4^th opposite party being the insurer of 1 & 2 is also liable to compensate the complainant.

Opposite parties 1 & 2 filed version contending the following:

Opposite parties 1 &2 admits that the wife of the complainant was under the treatment of the opposite parties. She was admitted on 18/11/05 with complaint of fever, headache and body pain. After basic blood and urine verification, the provisional diagnosis was viral fever. The patient was treated using ciprafloxacin and ceftariaxone for the first 2 days after test dose. Alongwith this she was treated symptomatically with paracetamol for fever, perinorm injection for vomiting. Injection cyclopam for abdominal pain, injection diclofenac 1M after test dose for body pain. Injection Ranitidine initially and injection partocid later for reducing hyper acidity. Patient also received injection. Ethanstylate for excessive bleeding. Clenora gel for oral ulcers and IV fluid as a supportive treatment for weakness and dehydration. The patient was regularly seen and examined by the physician and residential medical officer twice daily. Visiting gynecologist also examined the patient for menstrual bleeding.

Opposite parties denies the say of the complainant that the patient developed discolouration at 3.30 P.M on 20/11/05 after receiving an injection. The patient received Diclofenac one ampule at 10.15 A.M, injection Cefltriaxone 1 gm intravenously at 11.00 A.M after test dose given at 10.20 A.M. The next dose of injection cetriaxone was received at 10.20 P.M on 20/11/05. No colour change was noticed. If at all any trouble is there, immediate remedial measures have been adopted by 1^st opposite party. Further say of the complainant regarding colour change of urine, colour change of jaws and gums, blisters and burn on the skin, complaint of skin peeling off, severe burning sensation in the mouth etc. is false. According to opposite parties there was no such complaint while undergoing treatment under 2^nd opposite party hospital. Since the patient had intermittent fever 2^nd opposite party decided to start higher antibiotic stopping all other previous antibiotics. On 21/11/05 the deceased was started an injection cefactum 1 gm twice daily after test dose.

The patient did not die due to any of the injection administered by opposite parties 1 & 2. There is no negligence on the part of opposite parties. On 21/11/05 the patient had normal food. On 22/11/05, few more blood investigation was advised as the temperature was around 100⁰ F. On 22/11/05 at about 3 A.M. the patient had a spike of fever of 103⁰ F and the bystanders requested for immediate discharge. Bystanders were not ready for any further investigation or evaluation in the hospital. The patient was taken from the hospital at 4 A.M. According to opposite parties none of the medicines administered by the opposite parties were the cause of death of the wife of the 1^st complainant.

3^rd opposite party filed version stating that they have already replied to the lawyer notice issued by the complainant alongwith all the records as requested. The patient when brought to the 3^rd opposite party hospital was dealt with proper care and hence there is no deficiency in service on the part of the hospital.

4^th opposite party filed version stating that they are not the insurer of opposite parties 1 & 2, but opposite party No.5 has admitted that they are the insurer of opposite party 1 & 2.

The evidence led by the complainant consists of the chief affidavit. Ext.A1 to A12. and the testimony of 1^st and 2^nd complainant and two medical practitioners.

Opposite party filed chief affidavit and Ext.B1 to B4 were marked on their side.

Issues that arise for our consideration are

1. Whether opposite parties 1 & 2 has administered injection after taking test dose ?

2. Whether opposite parties 1 & 2 were negligent in treating the wife of the 1^st complainant

3. Liability of other opposite parties ?

4. If so, what is relief and cost entitled to the complainant ?

Issue I, II & III

Heard both parties in detail and has gone through the evidence on record.

Treatment of the wife of the 1^st complainant at the 2^nd opposite party hospital by the 1^st opposite party during the period of 18/11/05 to 22/11/05 is admitted.

The grievance of the complainant is with respect to an alleged medical negligence committed by opposite parties 1 & 2 on 20/11/2005 by administering an injection without test dose which has resulted in drug allergy and ultimately the death of the patient on 25/11/05. It was submitted by the complainant that within 5 minutes on administration of injection several complications developed which was informed to the nurse. But opposite parties 1 & 2 neither took any immediate steps to handle the situation nor shifted the patient to a competent hospital.

Opposite party 1 & 2 has given a detailed narration regarding the course of treatment followed in the case of the complainant's wife. It was submitted by the opposite parties 1 & 2 that on 20/11/05 the patient received diclofenac one ampule at 10.15 A.M, injection ceftriaxone 1 gm intravenously at 11 A.M after test dose given at 10.20 A.M. The next dose of the same injection was received at 10.20 P.M on the same day. No complication as alleged by the complainant took place. On 22/11/2005 the patient was discharged at the request of the bystanders.

In order to ascertain whether there is any negligence on the part of opposite parties 1 & 2, two questions has to be answered first. Firstly whether test dose was given before administering injection on 20/11/05 ?

Secondly whether the complications stated by the complainant actually happened and whether the situation warranted shifting to a competent hospital.

Ext.B3 page-1 of the case sheet of the Unity Hospital shows that 1^st opposite party has advised injection ceftriaxone and injection Diclofenac on 20/11/05 Page No.4 of Ext.B3, medication sheet shows that injection Diclo was given at 10.15 A.M. Against injection ceftriaxone in the same line written 10.20 A.M. and 10.20 P.M. 11.00 A.M. is written in the next line also. A word test dose is seen to be inserted above 10.20 A.M. which opposite parties 1 & 2 argues that the test dose was given at 10.20 A.M. and injection was administered at 11.00 A.M. and 10.20 P.M. The question to be decided here is whether the relevant page of Ext.B3 is a reliable evidence ? On the plain reading of Ext.B3 itself correction and insertion of the word test dose is clear. Further as per Ext.A8, the reply notice dated 04/04/06 issued by opposite party to the lawyer notice issued by the complainant requesting to send the medical records of the deceased patient, it was stated that all the records pertaining to the treatment was handed over to the bystanders of the patient. But it is seen that all the records were produced by the opposite parties 1 & 2 before the Forum at the time of evidence. This also raises doubt as to the genuineness of the entries of the document. The fact and evidence on record will make it clear that the drug was administered without giving test dose.

Admittedly the patient was admitted in the 3^rd opposite party hospital on 22/11/05. Ext.A5, Page 4 of the case sheet of 3^rd opposite party shows that the patient was seen by the duty doctor at the 3^rd hospital at 6.40 A.M on 22/11/05. On the same day the doctor has noted fever, giddiness and rashes all over the body of the patient. On going through Ext.B3, case sheet of the 2^nd opposite party hospitals none of the complaints as stated by the complainant like discolouration burning sensation, skin peeling off etc. has find a place in the case sheet. Even on the date of discharge which is at 3.00 A.M. on 22/11/2005 also pale tongue, severe mouth ulcer alone has been recorded. We do not believe that rashes all over the body noted by the 3^rd opposite party has developed within 3 hours . We feel that the opposite parties 1 & 2 has not made correct entries as to the correct physical status of the patient in their records. Ext.A5 Page 4 on the entries dated 23/11/05 it was noted toxic epidermal necrolysis and the cause is noted as Drug or underlying infection. Page 8 of Ext.A5 shows that the patient death was due to septicemia, toxic epidermal necrolysis, drug allergy and cardio respiratory arrest.

The evidence on record will go on to show that at the time of admission at the 3^rd opposite party hospital itself the patient had complaint of drug allergy. Complainant has not complaint about the treatment given at the 3^rd opposite party hospital. PW4 the doctor treated at the 3^rd opposite party hospital has deposed that the patient's condition at the time when PW4 examined was recorded in Ext.A5. Drug allergy is seen noted in Ext.A5. The reasons as deposed by PW4 for the cause of drug allergy is either due to allergy of the drug or infection. Regarding test dose also, PW4 has deposed as follows:

Ext.A4 GXv drug sâv test dose BWv sImSp¯sX¶v ]dªn«nà “ Toxic epidermal necrolysis F¶Xnsâ e£Ww BZyw skin  rashes h¶v Idp¯ \ndamhpw.  AXn\v tijw s]mÅ t]mse h¶v sXmen CfIn t]mIpw. CXn\p Hcp ImcWw acp¶pIfmWv. asÁmcp ImcWw infection BWv.

Opposite parties 1 & 2 has no case that patient had any sort of infection which has caused the drug allergy at the time of discharge at opposite parties hospital.

Opposite parties 1 & 2 has raised a contention that no histopathological examination or postmortem was done in order to ascertain the true cause of death. But PW3 the expert doctor, who is the then Head of Department of 3^rd opposite party hospital has deposed with respect to these issues as follows:

“Drug allergy tcmKnsb ]cntim[n¨v sXmenbn ImWp¶ hyXymksams¡ t\m¡nbmWv diagnosis sN¿p¶Xv. Cu tcmK¯nsâ fully developed stage GXv. M.B.B.S Doctor¡pw  diagnose sN¿m³ ]Ápw. tcmKn Poht\msSbpÅt¸mÄ  toxic epidermal necrolysis tcmK¯n\v histopathological test sN¿mdnÃ. 

Further PW3 during cross examination deposed as follows:

C¯cw tIkpIfn  95% Drug reaction sIm­ p Xs¶bmbncn¡pw.  Otherwise there should be a specific finding of viral infection.

As earlier stated opposite parties 1 & 2 has no pleading stating that drug allergy was caused by any infection. Further has stated that there was no case of drug allergy at the time of the treatment at the 2^nd opposite party hospital.

Considering the facts and appreciation of evidence on record we find that opposite party 1 was negligent in administering injection without applying test dose and in not recording correct entries with respect to the patient condition in the case sheet. Complainant has not alleged any medical negligence against 3^rd opposite party or claimed any relief against 3^rd opposite party. According to 4^th opposite party they are not the insurer of opposite party 1 & 2. Opposite party 5 has admitted that they are the insurer of opposite parties 1 & 2. Hence opposite parties 3 & 4 is exonerated from any liability towards the complainant. Opposite party 1 is liable to compensate the complainant on account of the medical negligence committed by them. 2^nd opposite party is vicariously liable for the act of opposite party 1. 5^th Opposite party being the insurer is also liable to pay the amount payable by opposite party 1 & 2 to the extent of their limit.

Issue No.IV

Complainant has claimed Rs.12,337/- being the medical expenses and Rs.5 lakhs as compensation. Certainly 1^st complainant has lost the care and company of his wife at the eve of the life and other complainants has lost the motherly affection. We are of the view that an amount of Rs.2 lakh as compensation will meet the ends of justice.

In the result complaint allowed. Opposite party 1,2 & 5 is jointly and severally directed to pay complainant an amount of Rs.2 lakh (Rupees Two lakhs only) as compensation along with Rs.3,000/- (Rupees Three thousand only) as cost of the proceedings. Order shall be complied within one month from the date of receipt of order, failing which the whole amount shall carry interest at the rate of 9% interest per annum from the date of order till realization.

Pronounced in the open court on this the 31^st day of August 2011.

Sd/-

Smt.Seena.H

President

Sd/-

Smt.Preetha G Nair

Member

Sd/-

Smt. Bhanumathi.A.K.

Member

APPENDIX

Exhibits marked on the side of the complainant

Ext.A1 – Lab Report of Unity Hospital dt.19/11/05

Ext.A2 – Ultra Sonography Report of Unity Hospital dt.20/11/05

Ext.A3 – Cash Receipt for Rs.1150/- issue by Unity Hospital dated 22/11/05

Ext.A4 – Letter addressed to Jubilee Mission Medical College by Unity Hospital

dtd.22/11/05

Ext.A5 - Inpatient Record of Jubilee Mission Medical College, Thrissur

Ext.A6 – Lawyer notice issued by complainant to 2^nd and 3^rd opposite party

dt.28/3/06

Ext.A7 – Reply to lawyer notice by 3^rd opposite party dated 4/4/06

Ext.A8 – Reply to lawyer notice by 2^nd opposite party dated 12/4/06

Ext.A9 – Rejoinder to 3^rd opposite party counsel dated 4/5/06

Ext.A10 – Reply to 3^rd opposite party to rejoinder of complainant dated 13/5/06

Ext.A11 – Bills for treatment and medicine purchased at the 2^nd opposite party

(16 items)

Ext.A12 – Bills for medicine and treatment at the third opposite party hospital

(24 items)

Exhibits marked on the side of the complainant

Ext.B1 – OP Card issued by Unity Hospital dated 6/11/05 (Original)

Ext.B2 – Medication Sheet issued by Unity Hospital (Original)

Ext.B3 – Case sheet of Unity Hospital (Original)

Ext.B4 – Photocopy of Insurance Policy of Unity Hospital issued by United

Insurance Co.Ltd.

Witness examined on the side of the complainant

PW1 – A.John Felix Thangaraj

PW2 – Jancy David

PW3 – Dr.M.V.Muraleedharan

PW4 – Dr.Anilkumar.C.R

Witness examined on the side of the opposite party

DW1 -Sebi.P.L

DW2 – Dr.Shaju

Cost Allowed

Rs.3,000/- allowed as cost of the proceedings