This is a complaint filed under Section 12 of Consumer Protection Act for an order directing the opposite party to pay `4,00,000  as compensation along with the cost of the proceedings..

          Complainant’s case in nutshell is as follows: Opposite party examined complainant aged 4 at his clinic on 17.9.2003 for fever and reviewed on 23.9.03 He was again taken to opposite party/doctor on  25.9.2003 due to  mild fever and he was prescribed the syrup “Nisflam’. On 29.9.2 003 patient was reviewed and advised to continue the same syrup. One month after this a rash was seen below the knee of the complainant and the same rashes were found on the hand two days later. 3 to 4 days later some rashes bluish colour was seen on the stomach. He was then taken to opposite party/doctor on 14.11.2003. Blood test was conducted on 15.11.2003. On seeing blood report doctor advised him to be admitted in Indira Gandhi hospital, Thalassery. Blood test revealed the platelet count was only 10000. Thereafter blood transfusion was done on 17.11.2003. Platelet count then increased to 1 lakh and the complainant was discharged on 18.11.2003 with an advise to test the platelet count after 3 days. Blood was tested on 3^rd day but found the platelet count very low. Complainant was taken to Dr.P.M.Shenoy. On going through the previous treatment record he was asked to stop Nisflam syrup. Since there is no increase in the platelet count even after one week treatment complainant was referred to Pariyaram Medical College on 17.12.2003 and he obtained discharge here from and got admitted to MIMS. Bone marrow test was conducted on 30.12.2012 and complainant was treated with IVIG Logs inj. for 5 days. He was discharged on 5.1.2004 with an advice to repeat the platelet count after 3 days and review after 2 weeks. Since Asymptomatic and cushigoid facies present he was again admitted to MIMS and treated till 31.1.2004, when discharged with advice to review after one week and opined to continue treatment for another six months with periodical platelet check up. There was steady increase of platelet count. No medicine was applied to increase platelet count but the count remained most constant complainant had no similar complaint before the consumption of ‘nisflam’ which contains nemesulide content. Complainant had no past history of bleeding manifestation. It is understood that doctors are not prescribing nemesulide since it was banned. It is only on account of negligent treatment of opposite party complainant happened to suffer his ailment. Even after seeing the patches on the body of the complainant opposite party has never instructed to stop nemesulide content syrup. The case for the low platelet count was the result of the drug. Complainant sent registered notice but opposite party has never caused any reply. Hence this complaint.

Pursuant to the notice opposite party entered appearance and filed version. The contentions on the part of opposite party are briefly stated as follows: - The complainant Nived examined by this opposite party and the drug of Nimesulide was prescribed. It was not a banned drug at that time. The said drug was prescribed only for a short period of treatment of the fever in September 2003 and was not advised to be continued. When the complainant was under his treatment there were no untoward effects of the drug. After the brief period of treatment, the complainant had no contact with him till 15.11.2003 when the patient was brought with history of bluish patches on his body. The opposite party made a proper diagnosis of Idiopathic Thrombocytopenic purpura(ITP). He was admitted Indira Gandhi Hospital. Necessary investigating of platelet count and peripheral smear examination was done. The patient was given omnscortial and later blood transfusion.  17.11.2003 platelet count was 1.1 lakh/cu.mm. The patient was discharged on 18.11.2003 with necessary medication and advice to follow up after 3 days with a repeat platelet count when the patient had approached on 14.11.2003 he was not on any drugs including Nisflam syrup. During the admission in November or at the time of discharge thereafter, the opposite party had not prescribed the said Nimasulide drug or any other anit pyretic drug and the patient was not having any fever at all. It is pertinent to note that Dr.P.M.Shenoy has not advised to stop Nimesulide, but has only advised not to give Nimesulide at that stage, when the platelet count was low.  Patient may not use an earlier prescribed medicine on his own by self medicine. The opposite party did not advise for more than a month prior to the illness of ITP which occurred in the patient. As per the history at Pariyaram Medical College, there was no history of any offending drug intake. The patient was not on Nimesulide for nearby 1 ½ months prior to onset of the disease in question namely ITP. The discharge summary given from MIMS also does not contain any mention about any drug intake in the patient. The illness in the complainant was conclusively diagnosed as ITP which is classically described as following a viral illness. Viral infection and not drugs are the cause of ITP. The illness of the complainant is not caused by the said drug. Not only Nimesulide, but all NSAID drugs can cause low platelet count.  There was no instruction to continue the drug and the complainant has no reason to do so since there was no fever at the time when he was brought with the illness to the opposite party on 14 November 2003. If at al the complainant has used the drug after the period of illness of which it was prescribed, it is at his own responsibility and risk and not on the advice of the opposite party. The drug has no connection with the causation of ITP which follows a viral infection. The diagnosis proved by bone marrow examination only ITP for which drug is not the cause. Drug induced thrombonocytopenia is a different entity and the illness of the complainant is different. This opposite party sent reply to notice of complainant asking for a copy of the concerned OP ticket which was in the complainant’s custody so as to give a detailed reply. But complainant has not furnished the same. Complainant’s attempt is to wrongly attribute the illness of ITP to the drug given for a short period nearly 1 ½ months prior to the illness. The illness of the complainant has taken proved beyond doubt as ITP which follows a viral infection. There is no negligence on the part of opposite party. Hence prayed to dismiss the complaint.

On the above pleadings the following issues have been taken for consideration.

1. Whether there is any deficiency on the part of opposite

     Party?

2. Whether the complainant is entitled for the remedy as

    prayed in the complaint?

3. Relief and cost.

The evidence consists of the oral testimony of PW1,CW1,DW1, Exts.A1 to  A17, Ext.B1, Ext.X1 and X1(a).

Issue Nos.1 to 3

          The complainant, 4 year old boy, for a brief period was treated by opposite arty and admittedly prescribed Nimesulide for the complainant. The allegation of the complainant is that the complainant was first examined on 17.9.2003 and reviewed on 23.9.2003. Due to   slight fever he was again taken to opposite party/Doctor on 25.9.2003 and prescribed the ‘Nisflam’ syrup. Patient complainant was reviewed on 29.9.2003 and asked to continue the syrup along with another medicine.

          On the brief, complainant has the case that after one month a rash was seen below the knee and two days after same rashes having bluish colour found on hand and further after 3 to 4 days same bluish colour rashes on stomach also. He was then taken to opposite party/Doctor on 14.11.2003 and on examination directed for blood test. On seeing blood report on 15.11.2003 opposite party advised to admit in Indira Gandhi Hospital, Thalassery. Blood report showed platelet count only 10000. Thus admitted him in the hospital on 15.11.2012. After blood transfusion blood test was done and platelet count found increased to 1.1 lakh. On 18.11.2003 he was discharged with advice to repeat platelet count after three days. On test platelet count seen again reduced so that child was taken before Dr.P.M.Shenoy. He advised to stop Nisflam syrup. After one week, complainant was referred to Pariyaram Medical College and after observation referred to Calicut Medical College where he was admitted on 17.12.2003. He was then discharged at request and admitted in Malabar Institute of Medical Science (MIMS) on 30.12.2003. There from bone-narrow-aspiration test was conducted and treated with IVIG Logs Injection for 5 days. After five days treatment he was discharged with advice to repeat the platelet count after 3 days and review after 2 weeks. The complainant was again admitted on MIMS on 24.1.2004 due to asymptomatic cushigoid facies present and treated till 31.1.2004. The investigation of platelet count during these periods showed gradual increase in platelet count. He was then discharged with an advice to continue treatment for six months and to undergo periodical platelet checking. Without taking any medicine there was a steady increase in platelet count and remains constant now.

          The main case of the complainant is that the complainant had no complaint of low platelet count prior to the consumption of ‘nisflam’ which contain Nimesulide content. The entire sufferings cause only because of the intake of ‘Nisflam’ syrup which it is understood that the doctors are not prescribing   nimesulide since it has got reactions, since it was banned.  Opposite party failed to diagnosis that pupura occurred due to the administration of Nimesulide. He failed to diagnosis that the loss of platelet count was the contra indication of the Nimesulide drug.

          Opposite party on the other hand contended that this is an attempt to link an illness which the complainant developed later to the treatment of opposite party for more than one month. He has further contended that opposite party prescribed Nimesulide since the fever was of high grade. It was prescribed only for a short period of treatment and did not advise to continue. After this brief period of treatment complainant had no contact with the opposite party till 15.11.2003 when the patient was brought with the history of bluish patches on his body. The opposite party had made proper diagnosis of idiopathic Thrombocytopanic purpura(ITP). The patient was given omnacortil and later blood transfusion. The repeat platelet count on 17.11.2003 showed higher platelet count of 1.1 lakh/cu.mm. He was discharged on 18.11.2003 with necessary medication and advice to follow up after 3 days with a repeat platelet count. But the complainant did not followed up as advised.

          Ext.A1 prescription proves that complainant was first examined by opposite party/Doctor on 17.9.2003 and reviewed on 23.9.2003.  Complainant alleged that the boy was again taken to him on 25.9.2003 with a mild fever and on that day opposite party has prescribed ‘Nisflam’. He further alleges that the patient was reviewed on 29.9.2003 and asked to continue the syrup Nisflam. The main allegation of the complainant is that following the intake of Nimesulide content syrup the multiple eccymotic patches were seen and on blood test the platelet content seen very low.

          It is seen that after the review on 29.9.2003 complainants was taken to opposite party on 14.11.2003 with the alleged bluish discoloration spot seen on body. Here arose certain points for consideration

1. Wheher complaint was advised to continue ‘nisflam’ syrup

    after the review on 29.9.2003,

2. How long the nisflam syrup had been continued?

3. Whether the multiple  eccymotic patches  seen on the

   body and coming down of platelet count had been caused

   as a result of intake of nimesulide content syrup?

          It is an admitted fact that complaint was given ‘Nisflam syrup’ on 25.9.2003. It was almost 1 ½ month later complainant was taken to opposite party again with complaint of presence of purpura spot seen on the body. The specific case of the complainant is that this complaint of purpura spot arose only due to the intake of nimesulide content syrup. Opposite party has taken the contention that the ‘Nisflam syrup was prescribed only for a short period of treatment and did not advised to continue. It is seen that complaint was reviewed on 29.9.2003 but no prescription seen given by opposite party on the day advising him to continue the nimesulide content syrup. Ext.A1 prescription does not show any indication to continue Nisflam syrup on 29.9.2003. No other evidence was produced by complainant to show that the nimesulide content syrup had been continued after 29.9.2003 by the advice of opposite party. Any how it could be seen that the complainant was admitted to Indira Gandhi Hospital, Thalassery on 15.11.2003 with history of bluish patches on his body. The illness was diagnosed as idiopathic Thrombocytopenic purpura (ITP). It is recorded in Ext.A2/B1 complainant adduced evidence by way of chief affidavit that platelet count was found 10000 on blood test. After two days treatment including blood transfusion repeated blood test was done on 17.11.2003 and found platelet count 1.1 lakh/cu.mm. Ext.A2 reveals that he was discharged on 18.11.03. Ext.A2 reveals he was treated by giving Roscillin inj and   Omnacortial Tab with blood transfusion. However, the patient/boy was taken to Dr.P.M.Shenoy on 25^th  November 2003 and continued treatment for twenty days. Ext.A3 is the prescription given by Dr.Shenoy. He has written in prescription slip that “advised not to nimesulide’. In the top of the prescription slip itself it is seen written in malalyalam that “ \nap-kp-sseUv acp¶p sImSp-¡-cpXp” Whatsoever this is a warning that the nimesulide content drug is so dangerous to complainant and to take precaution not to give that drug to him. But he did not make it clear that intake of ‘Nisflam’ syrup was the cause of the illness suffered by the complainant. But intention of his writing is definitely a warning that giving nimesulide content drug is dangerous to him. But Ext.A3 does not reveal that the intakes of Nisflam syrup were the cause of illness suffered by the complainant. It does not also reveals how long the Nisflam syrup had been consumed by the complainant. It cannot also be assumed that the complainant was advised by opposite party to take Nisflam syrup after the review on 29.9.2003. There is absolutely no evidence to that effect so as to establish the allegations of the complainant. But the initial warning of Dr.Shenoy who is also a medical expert undoubtedly make it clear that the Nisflam syrup was not safe drug and is likely to involve certain risks, though  not definite of what extent it might be. Anyway it is not easy to say that the complainant had been advised by the opposite party to use the alleged syrup continuously. It is also not possible say how long the said syrup had been taken by the complainant. Complainant has no  case that he had purchased Nisflam second time which naturally  leads to assume that the alleged drug was taken for a short period sufficient enough to consume not more than 60 ml as is shown in the cover Ext.A11 produced by the complainant. Anyhow, he did not produce purchase bill of Nisflam. So the quantity of syrup consumed cannot be assumed more than first bottle, which was prescribed for only a short period. PW1 deposed in cross examination that “25.9.2003 \p Cu acp¶p hm§n-b-X-ÃmsX ]n¶oSv Cu acp¶p hm§n-bn-«n-Ã. AXn-\p-ti-jT ]n¶oSv Cu acp¶p hm§n-bn-«nÔ. So this evidence makes it clear the alleged medicine was given for a short period only.

          The complainant alleged that after a week treatment of Dr.Shenoy complainant was referred to Pariyaram Medical college where he was kept for observation and then referred to Calicut Medical College on 17.12.2003. He was later taken to MIMS on 30.12.2003 after request discharge. Bone-marrow-aspiration test was conducted there from and final diagnosis was done as ‘Idiopathic Thrombocytopenic purpura”.PW1 in his cross examination deposed thus:“Ext.A5se final diagnosis Idiopathic Thrombocytopenic purpura F¶mWv. Dr.Siddique  ]dª Diagnosis Xs¶-bmWv MIMS \n¶p sNbvXXp F¶p ]ªm icn-bmWv”. Complainant also pleaded that opposite party has diagnosed ITP Idiopathic Thrombocytopenic purpura – So it can be safely conclude that the diagnosis of the opposite party doctor and that of the MIMS Hospital is admittedly the same.

          It is the definite case of the complainant that the purpura is seen in the body of the complainant only on account of intake of nimesulide content syrup, and also the cause for the drop of platelet count. As per the evidence it is the treatment of MIMS where from complainant attained relief from the alleged illness.Ext.A5 is the discharge summary dated 5.1.04 from M IMS, which shows recorded history and physical thus:

          “Admitted with history of recurrent purpura spot with

           drop in platelet count, treated elsewhere with steroids,

            no past history of bleeding manifestation”.

It can be seen that on 25.11.2003 complainant was taken to Dr.Shenoy and  had been under his treatment for a week.Ext.A2 reveals that he was discharged from Indira Gandhi co. operative Hospital on 18.11.2003 and his platelet count on 17.11.2003 was 1.1 lakh, which means platelet count was increased from 30000 to 1.1 lakh. On 25.11.03 the day when complainant was examined   recorded as 29000 which increased to 1 lakh on 28.11.03 and it again increased to 1.8 lakh on 3.12.2003. Ext.A4 shows that it has come down then on 16.12.03 to 32000. Ext.A4 is the discharge card dt16.12.2003 issued from Pariyaram Medical College. Ext.A3 does not show that Dr.Shenoy was of opinion that the illness of the boy was as a result of inducement of Nisflam syrup. Complainant has deposed in cross examination that: Dr.ShenoybpsS  \nK-a-\-¯n drug induced sIm­mWv Cu Akp-JT h¶Xp F¶p Fgp-Xn-bn-«nÔ. No records from Dr.Shenoy, Pariyaram Medical College, Calicut Medical College and MIMS shows that the illness of the boy had been caused as a result of drug inducement. No expert evidence also adduced to this effect. The second doctor treated the boy Dr.Shenoy also has not been examined to share his experiences with respect to the treatment and cause of illness. Hence  the available evidence on record is quite incapable of ascertaining that multiple ceeyomotic patches seen on the body of the complainant and coming down of platelet count had been caused as a result of intake of nimesulide content syrup.

          The vehement argument lodged by the counsel for the complainant has strongly attempted to establish that the purpura spot seen in the body of complainant with drop in platelet count only on account of in take of banned drug Nisflam syrup. He has also produced literature intended for an authoritative scrutiny. Ext.X1 is produced to show that nimesulide formulations for human use in children below 12 years of age were prohibited by Govt. of India. But it can be seen that the date of prohibition is 10.2.2011.The complainant undergone treatment by opposite party during the period from 17.9.2003 to 29.9.2003. So strictly speaking question of illegality cannot be leveled against opposite party in the case of prescribing ’Nisflam syrup. But the counsel for the complainant pinpointed in his arguments in a different angle that the drug being prohibited in several other countries earlier itself it had been  a live talk in the medical world supposed to catch attention of all the doctors including the opposite party doctor in the field at the relevant period. Even if it is admitted to be true for the sake of arguments, it has to be taken into account that the materials available before the Forum do not provide convincing evidence to that effect. So Forum cannot jump into a conclusion that opposite party prescribed the drug knowing well the after effect or reaction of the medicine, which generally could not be assumed.

          The counsel for the complainant stressed on the point that the Thrombocytopenia suffered by the complainant is drug-induced Thrombocytopenia.  The consistent case of the complainant is that consumption of nimesulide content drug ‘Nisflam’ syrup is the cause of illness suffered by him. Learned counsel argued that many common drugs can cause Thrombocytopenia. Most drugs induce thrombocytopenia by eliciting an immune response in which the platelet is an innocent bystander the platelet is damaged by compliment activation following in formation of drug-anti body complexes. Learned counsel over emphasis on the point that the best proof of a drug induced etiology is a prompt rise in the platelet count when the suspected drug is discontinued. The 14^th edition of Harrison’s principles of intra Medicine Volume 1 page 731 confirms the view argued by the learned counsel and on the basis  of this  authoritative literature it can be safely arrive at an opinion that prompt rise in the platelet count when the  suspected drug is discontinued  is a proof of Drug induced etiology.

          Close scrutiny of the facts of the case reveals that complainant consumed only one bottle Nisflam. There is no evidence to show that complainant brought the alleged drug ‘Nisflam’ more than one bottle. If the complainant had consumed more, at least the bill could have been produced. Further more complainant has no case that he had purchased more than one bottle. It was prescribed on 25.9.2003. Complainant though alleged that on 29.9.2003  he was reviewed and advised to continue the alleged syrup opposite party contended that it was not advised to be continued. No prescription goes to show that patient was advised to continue the syrup. No such bill of purchase of the syrup has been produced to show that he was advised to continue the same. If it was advised Ext.A1 prescription should have been shown written such advice to continue the syrup. The syrup ‘Nisflam’ prescribed when fever was higher grade on 25.9.2003. On 14.11.2003 there was no complaint of fever on the side of complainant. So the circumstances then existing seems to be there was no requirement of prescribing or directing to continue any anti fever drug. Hence in the absence of such prescription and in absence of production of any purchase bill with cover or bottle, it can only be assumed that he had purchased only one bottle. It has also to be taken into account that PW1 has deposed in cross examination that he had not purchased the alleged drug other than what he had brought on 25.9.2003. So it can very well be assumed that the total consumption of Nisflam syrup as per the advice of the opposite party was only 60 ml, which is clearly revealed on the cover Ext.A11. If the patient had consumed 1 tea spoon three time a day it can only be used for four days i.e. One teaspoon of 5 ml three times a day which is 15 ml per day. That means a 60 ml packet can only be used for 4 days. It was prescribed on 25.9.2003 and on the 5^th day he approached opposite party. On examination it is seen advised only tonic Zyron. Complainant did not produce the related prescription to show that the boy was advised to continue the ‘Nisflam’ syrup. Ext.A1 prescription goes to show that the patient was not asked to come again. It means in the usual course the patient had been progressively getting recovered from the ailment for which treatment had been taken.

          It was on 14.11.2003 the complaint had been taken to opposite party with he alleged bluish discoloration spot seen on the body. He was then hospitalized on 15.11.2003. There were 50 days gap after the last previous check up. Opposite party diagnosed the illness as idiopathic Thrombocyto panic purpura (ITP). The final diagnosis from the higher centre MIMS confirmed it to be correct. At the time when he was discharged from opposite party the patient count was 1.1lakh/cu.mm. Opposite party did not get further opportunity to treat the child since the complainant did not approach him for follow up treatment. Learned counsel for the complainant argued with stress that the opposite party did not refer the patient to higher centre. But it has to be taken in to account the fact that he who was  advised to follow up after three days with a repeat platelet count and he  never turned up to opposite party thereafter. Such contention would have been effective if he had reviewed with the opposite party for follow up as advised.

          Learned counsel for the complainant further argued that platelet count was reduced when complainant had taken nimesulide content medicine and not on account of fever. It was paused that opposite party did not  conduct bone marrow test and failed to diagnosis that the loss of platelet count was the contra indication of the nimesulide drug.

          It is the fact that the child was taken to Dr. Shenoy without approaching opposite party for follow up treatment. After 20 days thereafter he was taken to higher centre Pariyaram Medical college and there from to Calicut Medical college. Neither Dr.Shenoy nor the doctors in other two higher centers did not advise to conduct bone marrow test. The final diagnosis was done in MIMS. Ext.A5 is the discharge summary of MIMS. The final diagnosis was “Idiopathic thrombocytopenic purpura”. Ext.A2 reveals that the diagnosis made out by opposite party also was same “ITP”. Neither Dr.Shenoy nor the advanced Medical services centre Pariyaram or Medical College Calicut advised for bone marrow test leads to assume that, there is no meaning in blaming opposite party for not conducting bone marrow test. While taking into account the treatment done by other two higher centres and another efficient doctor Shenoy, it is not justifiable to blame opposite party on this point. It has also to be taken into account the fact that even if opposite party had not referred the complainant to higher centre; the complainant is a patient who got the opportunity to get the treatment of higher centers of course, because of the hard attempt of the parents. Whatsoever it is a fact that patient has not lost the opportunity to have the treatment of higher centre, though not referred by opposite party.

          Another point that has been emphasised in the argument of the leaned counsel of the complainant is that the opposite party failed to diagnosis that the loss of platelet count was the contra indication of the Nimesulide drug. The final diagnosis was done and ailment had been treated satisfactorily from MIMS. But there had been no such finding as contended above neither from MIMS nor from any other centers i.e. Pariyaram or Calicut medical college Not only that none of the treated doctors from any one of the higher centers were not entered in the witness box so as to give evidence to that effect. Learned counsel concluded on the point that the patient complainant suffered Drug induced Thrombocytopenic occurred on account of intake of Nimisulide content drug.  But none of the findings from any one of the hospital including MIMS where from final diagnosis was done and the disease was cured, never shows that the alleged drug was the reason for ITP. Hence there is no substance in the contention that opposite party has not diagnosed that the loss of platelet was contra indication of the Nimisulide drug.  The available evidence doesn’t prove that the reason or the ailment of the boy was of taking Nisflam syrup. The diagnosis of opposite party as idiopathic Thomboc to panic purpura was found proper with the finding of other doctors subsequently treated and of final diagnosis by bone marrow examination from MIMS. This reveals that opposite party has used his skill and diligence in attending the child. Hon’ble Supreme court held in Kusum Sharma & Ors Vs. Batra Hospital Research centre and Ors. Reported in I(2010)29(SC) that “ Doctor is not guilty of medical negligence as long as they perform their duties and exercise ordinary degree of professional skill and compliance.

          Nelson  Textbook Pediatrics’ 16^th Edition under chapter490 – Disorders of the platelets and the Blood Vessels provide clinical Manifestation of ITP thus: “ The classic presentation of IT P is that of a perfectly healthy 1 to 4 year old child who has the sudden onset of generalized petechale and purpura.  The parents often state that the child was fine yesterday and now is covered with bruises and purple dots. Often there is bleeding from the gums and mucous membrane particularly with profound thrombocytopenia (Platelet count<10 x 10◦/L) There is a history of a preceeding viral infection 1 to 4 wk before onset of the thrombocytopenia”.

          It is stated that “ A preceeding history of a  child hood ITP. The reason why some children respond to a common infection with an autoimmune disease remains unknown. Virtually every common infectious virus has been described in association with ITP”. Hence the probability of virus infection cannot be ruled out in the case in hand. Regarding treatment it has also pointed out that there is no consensus regarding the management of acute ITP and there is significant disagreement within the field”. This relevant question that is required to be considered is whether or not opposite party has excised ordinary degree of professional skill and competence.

          In the present case the treating  doctor/opposite party could diagnosis in the early stage itself, the illness same as that of final diagnosis, which reveals that he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art. In the celebrated and oftenly cited judgment in  Bolan V.Friern  Hospital Management committee observed that “ A doctor is not guilty of negligence if he has acted in accordance with  a practice accepted as proper by a responsible body of medical man in that particular art”.

          To establish liability on a treating doctor it must be shown(1) that thee is a usual and normal practice;(2) that the defendant has not adopted it; and (3) that the course in fact adopted is one no professional man of ordinary skill would have taken had he been acting with ordinary care. No such convincing evidence placed before the Forum so as to prove the negligence in a convincing manner. In the case in hand all the treating doctors in various Hospitals found holding the same diagnosis as that of opposite party undoubtedly reveals that he has exercised ordinary degree of professional skill and competence. No expert opinion supported the allegation of the complainant that   platelet count was reduced because of taking nimesulide content medicine. Even the literature produced does not help to conclude so.

          17^th Edition Harrison’s Internal Medicine Volume I section 3 deals with Disorder of platelets and vessel walls in page 721 under the Caption Immune Thrombocytopenic Purpura (ITP). It is explained that “Immune Thrombocytopenic Purpura (ITP; also termed idiopathic thrombocytopenic purpura) is an acquired disorder leading to immune – mediated destruction of platelets and possible inhibition of platelet release from the megakaryocytic. In children it is usually an acute disease, most commonly following an infection”. It reveals first of all that idiopathic thrombocytopenic purpura is another name of immune thrombocytopenic purpura. The impression that there are two different terms indicating different type of illness is wrong and has been made clear stating that immune thrombocytopenia purpura also termed idiopathic Thrombocytopenic Purpura. Secondly it has also brought to light that in children it is usually an acute disease, most commonly following an infection.  When there is such an authoritative opinion it is not easy without cogent and convincing evidence to discard the contention of opposite party that viral infection was the cause for the disease of the child.

          The explanation that has been given with respect to NIMESULIDE in Good man and Gilman’s  the pharmacological Basis of Theraputics  Ninth Edition(International Edition)Section IV page 644 that “ NIMESULIDE is rapidly and extensively  absorbed  after oral administration. The drug can be given as a rectal suppository but is about 70% as bioavailable rectally as orally administered. The compound is extensively (greater than 95%) bound to plasma proteins. The average half life for elimination is about 3 hours” is also a point to be taken into account. This is a case wherein , the child was brought to opposite party after 50 days  gap of prescribing the drug “Nisflam”. In page 196 of the book it is also given that “Nimusulide” is almost completely absorbed orally, 99% plasma protein bound, extensively metabolized and excreted mainly in urine”.  So it creates doubt with respect to the cause of  illness and there is no footing, however, to rule out the possibility of infection. It is true that many drugs have been associated with Thrombocytopenic Purpura. But “Nisflam” did not found place in the listed table as commonly used drug that cause Thrombocytopenic Purpura in any of the literature. Under such circumstances in order to come into conclusion that the intake of “Nesflam” is the prima cause of illness of the child and curse of all misfortunes, it is necessarily required cogent and convincing evidences. Complainant could not establish the alleged drug has in connection with the causation of ITP

          On going through the evidence and analyzing the same, we are of opinion that the complainant failed to prove his case with cogent and convincing evidence. Hence the issues 1 to 3 are answered against the complainant.

In the result, the complaint is dismissed. No cost.

    Sd/-                      Sd/-                   Sd/-

        President               Member                Member

                         Sd/-                     Sd/-                    Sd/        

APPENDIX

Exhibits for the Complainant

A1.Prescription issued by OP-

A2.Discharge crd issued by Indira Gandhi Hospital

A3. Prescriptionissed by P.M.Shenoy

A4. Discharge card issued by Pariyaram Medical College

A5. Discharge summary issued by MALABNAR Institute of Medical science

A6. Copy of the lawyer notice sent to OP

A7.Reply notice

A8. Notice issued to OP

A9. Reply

A10 & 11. Blood Text reports

A12. Cover of the syrup Nisflam

A13.Desabhmani daily dt.22.6.2007

A14. Discharge summary issued from MIMS

A15.Note Book (treatment details  - Nived)

A16.Prescription issued by Dr.A.Riyaz

A17. Bills issued from MIMS

Exhibits for the opposite party:

B1. Doctor’s record sheet

Exhibits for the court

X1. Notification dt.10.2.2011 of Ministry of Health and Family Welfare

       Dept.

Witness examined for the complainant

PW1.Complainant

 Witness examined for the opposite party:

Dr.K.P.A.Siddique

Witness examined for the court

CW1. T.Reghunathan

        / forwarded by order/

          Senior Superintendent