IN THE CONSUMER DISPUTES REDRESSAL FORUM, ALAPPUZHA
Wednesday the 30th day of November, 2016
Filed on 22.12.2014
Present
1. Smt. Elizabeth George (President)
2. Sri. Antony Xavier (Member)
3. Smt. Jasmine D (Member)
in
CC/No.356/2014
Between
Complainant:- Opposite parties:-
Sri. Joshy K. George 1. Dr. Radhakrishnan, M.B.B.S.
Parambil Padeettathil Consultant Psychiatrist
Mulakkuzha, Chengannur Century Hospital, Mulakkuzha
Chengannur – 689 505
2. Medical Superintendent
Century Hospital, Mulakkuzha
Chengannur – 689 505
O R D E R
SMT. JASMINE D. (MEMBER)
The brief facts of the complaint are as follows:-
The complainant was taken to the 2nd opposite party hospital with symptoms of psychomotor retardation, irrelevant talk and inappropriate smiling on 25.3.2014 and was under the treatment of first opposite party and he was discharged on 31.3.2014. The discharge summary revealed that the complainant was given Injection Prolinate 1 cc, Tablet Resque plus 0-0-1, Tablet Lorapin 25mg. 0-0-1, Tablet Pcitane 1-0-1. According to the complainant during the course of admission the first opposite party was not present in the hospital for most days and there were no competent junior doctors to look after the complainant and he was mainly managed by a social worker. The complainant further alleged that the injection Prolinate was given without taking a test dose. Thereafter follow up check-ups were done. But on 27.4.2014 the complainant was again admitted to the 2nd opposite party hospital with symptoms of fever, poor oral intake and throat pain. A Psychiatry consultation was sought and he was advised to stop antipsychotic medication and he was admitted in the medical ICU and was discharged on 6.5.2014 from the 2nd opposite party hospital in a semi paralytic state. Thereafter the complainant was taken to the C.M. Hospital at Pandalam on the same day itself (6.5.2014) and was admitted there and was discharged on 9.6.2014. Thereafter the complainant was admitted at Santhula Trust Hospital, Koothattukulam and was under the treatment for a period from 19.6.2014 to 14.8.2014. According to the complainant the first opposite party has wrongly diagnosed his disease as Catatonic Schizophrenia instead of Neuroleptic malignant syndrome and he did not receive the proper treatment for Neuroleptic malignant syndrome which was caused by the previous administration of anti psychotic medication. Due to the delay in getting correct diagnosis and treatment the complainant had to suffer very badly for more than 3 months and hence filed this complaint alleging medical negligence on the part of the opposite parties.
2. Version of the first opposite party is as follows:-
The complaint is not maintainable. There is no negligence or deficiency in service on the part of this opposite party and the complainant is not entitled to get any reliefs as prayed for. Considering the clinical history, clinical presentation and mental status examination, the first opposite party made a provisional diagnosis of Schizophrenia disorder with Catatonic features. There was a strong family history of clinical psychiatric illness with psychotic features of the complainant’s mother. The first opposite party has discussed with the complainant’s father regarding the condition and an informative counseling was given regarding the need for regular treatment. The patient was not co-operative to treatment and refused to take drugs a low dosage anti-psychotic drugs along with Pacitane to avoid side effects. The patient showed improvement by treatment but he was discharged on 31.03.2014 as per request of the relatives against medical advice. One dose of injection Prolinate 1cc was administered before discharge and prescribed anti-psychotic medicines along with tablet Pacitane. The complainant came to the first opposite party’s outpatient department along with his father on 15.04.2014 and he was found to be better and active. Emotional state became better and eye to eye contact was maintained and he was co-operative. The patient was given injection Prolinate 1cc as IM and prescribed oral medicines with an advice to continue oral medication without fail. On 22.04.2014 the complainant was brought to OPD and his father reported that he was not taking oral medicines as prescribed and hence IP management was advised. But the father of the complainant did not prefer IP treatment and he was advised to continue oral medication. On 27.04.2014 the patient was brought to the casualty with complaints of poor intake, fever with throat pain for 2 days and with a history of sustained injury on right thigh due to fall and admitted in medicine department with diagnosis of sepsis, right lower lobe pneumonia and schizophrenia on treatment. The patient was managed in the medicine department with appropriate antibiotics and supportive treatment. On 29.042014 the patient was referred for psychiatric consultation and on examination he was conscious and oriented, no tremors or rigidity, difficulty in taking food and uncooperative. All psychiatric medications stopped and advised to continue medical supportive management. The first opposite party had treated the patient in strict regard to accepted medical practice and protocol based on proper diagnosis. The patient had been suffering from Schizophrenic form disorder with catatonic features well evidence from clinical manifestations and symptoms and had a strong family history as well. He was treated with medicines in standard dose as per pharmacological guidelines and inj. Prolinate was given in a period of one month as the patient was not co-operative for oral medications. Test dose is not required for the injection Prolinate given as IM. The complainant was admitted in medical department and based on proper diagnosis started on antibiotics and other supportive treatment. The complainant had diagnosed Schizophrenic form disorder with Catatonic features and he was treated with standard medicines in accepted dosage. Neuroleptic malignant syndrome is a toxic effect of any antipsychotics and the diagnosis was made on the basis of proper clinical correlation. There was no misdiagnosis or wrong diagnosis in the complainant’s case as alleged in the complaint. Neuroleptic Malignant Syndrome is most uncommon and rarely develops as side effect of any anti-psychotic regardless of dosage and usually a self limiting medical condition which requires only supportive treatment. There was no delay in diagnosis and he was properly managed in the department of medicine as per accepted medical practice. This condition is not caused due to any negligence or deficiency in service on the part of the first opposite party. First opposite party is not liable to compensate the complainant either jointly or severally and the opposite party is having qualification and experience of 30 years as a consultant Psychiatrist. Hence the complaint may be dismissed with costs to the opposite party.
3. Version of the 2nd opposite party is as follows:-
The treatment records of the complainant reveals that the patient named Joshy K. George, aged 20 years was brought to the casualty of Century Hospital on 25.3.2014 at about 8 p.m. with psychomotor retardation like irrelevant talk, multism, bizarre posturing, laughing to self and angry out burst from 3 to 4 days, he was seen by CMO. The father informed that the complainant was a final year B.Com. student and has back papers for the 1st and the 2nd years and there was no such incident earlier. The family history also reveals the mother of the complainant was having prolonged psychiatric illness. On examination the complainant seems oriented, restless, smiling without reason, irritable and not responding to questions. The chest and CVS were found normal. As the psychiatrist was not available then, the casualty medical officer after a telephonic discussion with the psychiatrist the first opposite party, admitted the complainant in the psychiatric department and started low dose of Injection Serenace 2.5 mg IM & 2.5 mg IV, Injection Phenergan 25 mg IV SOS and IV 5% Dextrose 500 ml as per the first opposite party’s advice. On 27.3.2014 the complainant was seen by first opposite party, the Psychiatrist to whom the father of complainant disclosed that there was a gradual change of behavior of the complainant for last 2-3 months with Multism present, sleep disturbance with insomnia, irrelevant talk, emotion was constricted in range and apathy was present. He had also given a history that at times he maintained catatonic postures, not communicable, occasional muttering and uncooperative. The father also disclosed that complainant’s premorbid personality as introvert, less friends, prefers to be lone sensitive and cool tempered a schizoid personality. That the first opposite party after a detailed examination of complainant and considering the premorbid personality, clinical presentation, mental status examination and a strong family history, made provisional diagnosis of Schizophrenic form disorder with catatonic features and started usual line of treatment as per standard protocol. On 22.4.2014 the complainant was brought to OP with mild tremor, irrelevant talk, insomnia, apathy and anxious. He was seen by OP1 doctor. On enquiry the father disclosed that there was discontinuation of medicines including pacitane as advised be OP1 doctor and as the complainant was not willing for an admission then, other medicines were prescribed and he was advised for a review within a week. On 27.4.2014 the complainant was brought to the hospital and admitted in medical ICU with H/o fever, jaundice, throat pain with a diagnosis of pneumonia, a different ailment and started usual line of antibiotics and other supportive treatment. As there was no tremors and rigidity and as the patient was also oriented, all psychiatric medications were stopped. Injection Phenergan 25 ml IV bed time and other supportive treatments were continued. Tablet diazepam was prescribed on 3.5.2014 while noticed mild rigidity. On 5.5.2014 the patient shown symptoms of neuroleptic Malignant Syndrome. The parents were explained about the situation and as they were not interested in continuing treatment in OP2 hospital and wanted for a discharge, the complainant got discharged from OP2 hospital on 6.5.2014. The complainant had given only the required dosage of injection prolinate 1cc an intra muscular injection as per standard protocol which did not require any test dose as alleged in the complaint. It is also denied that NMS was caused due to the previous administration of antipsychotic medications and no treatment is provided to the complainant. On diagnosing NMS, on the request of the parents, the complainant was discharged from OP2 hospital, as they wanted patient to be treated in some other hospital of their convenience. NMS (Neuroleptic Malignant Syndrome) is not an illness but a toxic effect of antipsychotic occurring 1/10000 of individuals more in male patients and usually lasts up to 7 to 20 days which is a self limiting medical condition requires supportive medical treatment for which the parents of the complainant were not willing. That the complainant was suffering from Schizophrenic form disorder with catatonic features which is a very serious illness developing in young age and can retard all his future social, emotional, as well as family life. Though the opposite parties were trying to give him a scientific treatment, the relatives did not co-operate with it. There was no follow up by complainant thereafter and this opposite party did not know anything about present allegations in the complaint. All scientific and standard treatment procedures were carried out on your client with strict aseptic precautions with utmost care and caution while in OP2 hospital. There is no deficiency in service on the part of the 2nd opposite party, hence the complaint is dismissed.
4. The complainant was examined as PW1. Documents produced were marked as Exts.A1 to A10. The 2nd opposite party produced original case records before the Forum which were marked as Exts.B1 and B2.
5. Considering the allegations of the parties, the Forum has raised the following issues:-
1) Whether there is any deficiency in service or negligence on the part of the opposite
parties?
2) Whether the complainant is entitled to get the relief sought for?
6. Points 1 and 2:- The 1st and 2nd points can be considered together. The complainant has filed this complaint for compensation for medical negligence. Medical negligence means negligence resulting from the failure on the part of the 1st opposite party to act in accordance with the medical standards which are being practiced by an ordinarily and reasonably competent person practicing the same. The medical practitioner’s owe a duty to their patients to exercise reasonable care in carrying out their professional skills of diagnosis, advice treatment or surgery. In order to find out the above propositions we have to see whether there was any want of reasonable degree of skill or willful negligence on the part of the first opposite party in the treatment of the complainant, whether there was any lapse on the part of the first opposite party. To answer this question we have to peruse the complaint, version, proof affidavit filed by the parties, oral testimony of the witness and the evidence adduced by the parties.
7. The case of the complainant is that the complainant was taken to the 2nd opposite party hospital with symptoms of Psychomotor retardation like irrelevant talk and inappropriate smile on 25.3.2014 and was under the treatment of first opposite party and he was discharged on 31.3.2014. Thereafter follow up check-ups were done. But on 27.4.2014 the complainant was taken to the 2nd opposite party hospital in a serious condition with symptoms of poor oral intake and throat pain and he was admitted in the ICU and was discharged on 6.5.2014 in a semi paralytic state. Thereafter the complainant was taken to the C.M. Hospital, Pandalam and admitted there on the same day itself and was discharged on 9.6.2014. Later the complainant was admitted Santhula Trust Hospital, Koothattukulam for a period from 19.6.2014 to 14.8.2014. According to the complainant all this hardships and inconvenience are caused to the complainant due to the wrong diagnosis of the first opposite party and hence filed this complaint alleging medical negligence seeking a total compensation of Rs.20 lakhs. According to the opposite party he had treated the patient in strict regard to accept the medical practice and protocol based on proper diagnosis. The patient had been suffering from Schizophrenic form of disorder with Catatonic features well evident from clinical manifestation and symptoms and had a strong family history as well and the patient was treated with medicines in standard dose and test dose is not required for giving Injection Prolinate as Intra muscular.
8. The main allegations of the complainant for alleging medical negligence that the first opposite party has made a wrong diagnosis as Schizophrenia instead of NMS and the first opposite party has administered Prolinate injection without taking a test dose and due to the wrong diagnosis, the complainant has suffered all these complications and sufferings. The complainant has produced 10 documents to substantiate his allegations. Ext.A1 is the copy of legal notice issued to the opposite parties dated 4.11.2014, Ext.A2 is the postal receipts and Ext.A3 is the A/d cards. Ext.A4 is the discharge summary from the 2nd opposite party hospital, Ext.A5 is the discharge summary from Christian Mission Hospital, Pandalam dated 9.6.2014, Ext.A6 is the discharge summary from Santhula Trust Hospsital, Ext.A7 is the cash bills from the 2nd opposite party hospital, Ext.A8 is the cash bills from C.M. Hospital, Pandalam, Ext.A9 is the cash bills from Santhula Trust Hospital and Ext.A10 is the reply notice issued by the 2nd opposite party. From the documents it can be seen that the complainant has underwent treatment at C.M. Hospital, Pandalam and Santhula Trust Hospital and incurred so much amount for the treatment.
9. The mere allegation will not make a case of medical negligence unless it is proved by reliable evidence and is supported by expert evidence. A doctor is not to be held negligent simply because something went wrong. Complainant failed to prove a prima facie case of deficiency in service or negligence on the part of the opposite parties. The complainant failed to substantiate his allegation either by expert evidence or by medical literature. There was no expert evidence or medical literature to show that the procedure adopted by the 1st opposite party was ill advised. According to the 1st opposite party he had treated the patient properly and he performed his duties for the best of his ability with due care and caution. The 1st opposite party examined the patient and had exercised reasonable skill in diagnosis, advice and treatment. On scanning the entire evidence, we cannot see willful negligence or want of reasonable care on the part of the first opposite party. There is no evidence to prove the case of the complainant. Therefore, we are of the considered view that there was no negligence caused by the first opposite party in diagnosis and treatment of the patient. First opposite party treated the patient with proper care and caution. Therefore, we are on the basis of forgoing discussions do not find any medical negligence committed by the opposite parties and accordingly the complaint is dismissed.
In the result, the complaint is dismissed.
Pronounced in open Forum on this the 30th day of November, 2016.
Sd/- Smt. Jasmine.D. (Member) :
Sd/- Smt. Elizabeth George (President): Sd/- Sri. Antony Xavier (Member) :
Appendix:-
Evidence of the complainant:-
PW1 - Joshy. K. George (Witness)
Ext.A1 - Copy of the legal notice
Ext.A2 - Postal receipts (2 Nos.)
Ext.A3 - A/d cards (2Nos.)
Ext.A4 - Copy of the discharge card of Century Hospital
Ext.A5 - Copy of discharge summary of Christian Mission hospital
Ext.A6 - Copy of discharge summary of Santhula Trust Hospital
Ext.A7 - Copy of bills from Century hospital (11 Nos.)
Ext.A8 - Copy of bills from Christian Mission Hospital
Ext.A9 - Copy of bills from Santhula Trust Hospital
Ext.A10 - Reply notice dated 17.12.2014
Evidence of the opposite parties:-
Exts.B1 & B2 - Original case records from Century Hospital
// True Copy //
By Order
Senior Superintendent
To
Complainant/Opposite party/S.F.
Typed by:- pr/-
Compared by:-
