KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM.

APPEAL No. 279/05

JUDGMENT DATED:  31-8-2011

PRESENT:

JUSTICE SHRI. K.R. UDAYABHANU              :  PRESIDENT

SHRI. M.K. ABDULLA SONA                           :  MEMBER

APPELLANTS

1.      Sir Dorabji Tata Trust Aided Hospital

Chottanikkara,

Rep. by its Secretary – Dr. S. Krishna Iyer.

2.      Dr. Paul Chaley

C/o. Sir Dorabji Tata Trust Aided Hospital,

Chottanikkara.

3.      Dr. S. Krishna Iyer

C/o Sir Dorabji Tata Trust Aided Hospital,

Chottanikkara.

(Rep by Advs. George Cherian & N. Subramaniam )

Vs

RESPONDENT

Rajeswari, W/o late Hariharan

Puthukunnathu House,

Kadungammangalam,
Thiruvankulam P.O., Ernakulam.

(Rep by Adv. K.S. Madhusoodanan)

JUDGMENT

JUSTICE SHRI. K.R. UDAYABHANU:   PRESIDENT

The appellants are the hospital and doctors who treated the deceased. The appellants are under orders to pay of Rs. 2,00,000/- as compensation and Rs. 2,000/- as costs in OP 294/03 in the file of CDRF, Ernakulam.

2.      The complainant is the widow of the deceased who died due to rat fever on 16-12-02. It is the case that on 10-12-02 the patient felt body pain and fever and on 13-12-02 he was admitted at the 1^st opposite party hospital as inpatient. The deceased was treated by the opposite party doctors and certain lab tests and X-ray were taken. It is alleged that on
15-12-02 the complainant wanted discharge of the patient for admitting him at Amrita Institute of Medical Science (AIMS) which was not allowed by the opposite parties. On 16-12-02 the 4^th opposite party doctor told that the deceased is suspected to be infected by Jaundice and that there is no facility in the opposite party hospital for further treatment. The deceased was discharged at about 1pm and he was admitted at 2 pm at AIMS. On examination at AIMS it was found that he was infected by Leptospirosis (rat fever) and that his kidney and liver have been damaged. The patient died at 10.05 pm on 16-12-02. The case of the complainant is that there was serious negligence on the part of the opposite parties in treating the deceased and that it is on account of the above negligence that the person died.  A sum of Rs. 5,00,000/- was claimed compensation.

3.      The opposite parties 1 to 4 have contended that the deceased was admitted on 13-12-02 at about 6 pm on complaints of fever, pain in both legs from hip downwards, nausea, body ache, breathing difficulty and vomiting. The resident doctor diagnosised it as a case of viral fever. The patient was advised to be admitted to the hospital since there were some cases of leptospirosis reported. Chances of that disease was also kept in mind in administrating the treatment. The patient was given medicines for fever and breathing difficulty. On 14-12-03 the 2^nd opposite party and the 4^th opposite party doctors examined him. In the evening of 15-12-02 the patient complained of nausea. On 16-12-02 some tests were conducted and the Physician was consulted and it was confirmed that the patient was suffering from hepato renal failure probably due to Leptospirosis. It was accordingly informed to the relatives of the patient and he was discharged at 11 am. It is the case that the only test for determination of Leptospirosis is doing, culture of blood, which would take about 10 days for getting the result. There was no lapse at all on the part of the opposite parties.

4.      The evidence adduced consisted of the testimony of PWs 1 and 2, DWs1 and 2 and Exts. A1 to A3, B1 to B9.

5.      The Forum has noted that the doctors at AIMS could confirm that the patient was suffering from rat fever within few hours of admission of the patient at that hospital. The explanation of the opposite party doctors that the test to detect rat fever would take about 10 days to get the results stands belied. It was also noted that DW1 the 4^th opposite party doctor has stated that even on the next day of admission the doctors suspected that the patient was suffering from rat fever and that if it was so the patient ought to have been referred to another higher centre for better treatment immediately. It was found that the lapse on the part of the opposite party to refer the patient at an early stage to a higher centre resulted in his death.

6.      The contention of the counsel for the appellant is that the opposite parties had conducted the required tests but there were no indications of rat fever.  It was also contented that the opposite parties had administered the antibiotic Doxycycline which is a medicine administered, for rat fever and hence there is no negligence on the part of the opposite parties. It is also contented that there is a gestation period and that it would not be possible to detect the illness in the absence of the blood culture test for which facilities are not available in Kerala and the results of which would be obtained only by 10 days. It is also contended that the diseased was infected by a fulminant variety of Leptospirosis i.e. Weil’s syndrome which has got a very high mortality rate. The above severe form of rat fever is characterized by jaundice and renal dysfunction, hemorrhagic diathesis and high mortality. The counsel has relied on Harrisons, Principles of Internal Medicine (P.P 1055 to 1058, 15^th edition) Therein at page 1057 it is mentioned that in milder cases oral treatment with tetracyclin, doxycycline, ampicillin or amoxicillin should be considered. It is pointed also out that in the above quoted test book at page 1057 it is mentioned that in cases of severe leptospirosis renal failure may develop, often during the second week of illness. 

7.      The counsel for the appellant has stressed on the statement of PW2 in the cross examination that on the next day of admission itself they suspected that the deceased was having rat fever. It was also mentioned by DW1 the 4^th opposite party doctor that there was no facility to detect rat fever or for treating the same in the opposite party hospital. Infact there was no explanation as to why the patient was retained till the16^th.  PW2 the doctor who treated the deceased at the AIMS has testified that the deceased was brought to the AIMS in a critical condition. The serological test done at AIMS found as positive for leptospiral 1 gm. PW2 has also mentioned that on antibody test the result which will be available in 24 days also the illness can be detected. He has stated that during the second stage of the illness the recovery will be difficult. He has also stated that the treatment ought to have started in the first stage itself. The particular bacterium sometimes became highly virulent and produce multi organ failure. He has also stated that the deceased was afflicted by the fulminant variety of the bacteria. The failure of liver and kidney would be quick for the patient if he was an alcoholic. The rate of failure of liver and kidney etc would be aggravated in such situations. Dialysis and ventilator support is required for such patients which was not available at the opposite party hospital. PW2 has stated that certain symptoms of the rat fever can be the same in certain cases of viral fever also. It is the case of the opposite parties that the patient was an alcoholic. The same is not seen noted in Ext. B1 copy of the OP ticket issued at the time of admission. In Ext. B5 the prescription dated 16-12-2002 it is mentioned that he used to consume alcohol heavily 1 year ago and it is infrequent since then. Smoking is also mentioned as + +. It has also to be noted that there is no expert evidence to sustain the case that the administration of doxycycline alone is sufficient for treatment of rat fever. Doxycycline is only one of the medicines administrated in milder cases as noted at page 1057 in the Harrison’s.

8.      We find that the very admission by DW1 the 4^th opposite party doctor at opposite party hospital that they suspected the deceased was having rat fever on the next day of admission itself ie, on 14-1-02 considerably strengthen the case of the complainant that there was lapse on the part of opposite parties in not referring the diseased to a higher centre. It is also admitted in the version that there were reported cases of rat fever and that they treated the deceased keeping in mind the above fact. We find that the above statement is not sufficient to explain the delay the referring the diseased to a higher centre. We find that there is serious lapse on the part of the opposite parties in not referring the diseased to a higher centre at the earliest. The deceased was critical when he was admitted on the AIMS. It is noted in the treatment records of AIMS that the complainant was having Weil’s disease and acute renal failure for which mortality rate is very high as noted in Harrison’s.

9.      The deceased was aged 50 years; which is mentioned in the complaint and in the treatment records. There is no proper evidence as to the income of the deceased. In the circumstances, and considering the fact that it has been not established that death was caused exclusively due to the lapse on the part of the opposite parties to refer the deceased to a higher centre earlier the direction to pay compensation of Rs.2,00,000/- is modified to Rs.1,00,000/-. The direction to pay cost of Rs.2,000/- is sustained. The complainant will be entitled for interest at 9% on the amount of compensation from the date of complaint ie. ­25.7.03. The opposite parties are directed to make the payment within 3 months from the date of the receipt of this order failing which the complainant will be entitled for interest at 12%  from 31-8-2011 the date of this order.

In the result, the appeal is allowed in part as above.

The office will forward the LCR to the Forum along with the copy of this order.

JUSTICE K.R. UDAYABHANU:   PRESIDENT

M.K. ABDULLA SONA:    MEMBER

DA