Per Shri P.N. Kashalkar, Hon’ble Presiding Judicial Member
1. This complaint has been filed by Mrs.Shashiprabha Singh, wife of deceased Anil Kumar Singh alleging deficiency in service on the part of Sir J.J. Hospital and its two doctors. J.J. Hospital is cited as ‘Opponent No.1’, Dr.Ms.Alka Deshpande as ‘Opponent No.2’ and Dr.Rakesh Sargaokar as ‘Opponent No.3’.
2. According to the complainant her husband deceased Anil Kumar Singh was an employee of Central Government of India in Naval Armament Depot, Karanja. Her husband was employed in Indian Navy and was drawing a salary of `17,000/- per month. According to her, her husband Anil Kumar Singh developed some complications regarding his health. He has loose motions, abdominal pain and fever for about two years and he was admitted in J.J. Hospital in Ward No.12B on 06/08/2003 and was under treatment of the opponents. According to the complainant, after checking her husband-Anil Kumar Singh, opponent No.2-Dr.Deshpande prescribed an injection “PEGASYS Peginterferon alfa-2a”. It was a very costly injection, but opponent No.2 wrote a letter to the Central Government Health Scheme on 23/08/2003 and requested them that they should provide PEGASYS injection 180 mg. once a week for total period of 24 weeks. She also prescribed certain other medicines. Exhibit-B is the copy of said letter. According to the complainant said injection was given to her deceased husband for 24 weeks. In addition, some medicines were also prescribed and given to her husband Anil Kumar Singh. But, condition of Anil Kumar Singh never improved. The complainant averred that during said period, opponents did not bother to check husband of the complainant about the effect of the injection given to him and due to administration of said injections, he developed ‘Liver Cirrhosis” and her husband died on 25/12/2004. Exhibit-D is the copy of postmortem report issued by the Indira Gandhi Rural Hospital. Complainant says that cause of death was ‘terminal cardio respiratory arrest due to liver cirrhosis’. The complainant pleaded that her husband was checked by opponent No.3, who by letter dated 01/03/2004 referred husband of the complainant to Dr.Samir Shah of Jaslok Hospital. Complainant pleaded that doctors of Jaslok Hospital and Bombay Hospital (he was also admitted in Bombay Hospital on 18/10/2004) orally suggested that the injections given to Anil Kumar Singh was not necessary and he could be treated by medicines alone and his liver become decompensate because of injection ‘Pegasys’ and they were negligent in handling her husband. She alleged that due to negligence of the opponents, her husband died at the early age of 46 years.
3. The complainant pleaded that both the doctors had not monitored the condition of the patient after each injection was given and after 23rd injection, it was observed that his stomach, hands and legs had a swelling. She had brought this fact to the notice of Dr.Sargaokar-opponent No.3, but he ignored the same. After 24 days he asked him to do sonography. In the sonography, it was revealed that there was water in the stomach. Then 1½ liters of water was taken out from his stomach and the rest was dried with medicines. She pleaded that due to effect of injections, liver was decomposed. The injection kills the cells of liver because the virus of Hepatitis B is situated inside the liver cells. So, with every injection the liver decomposes. Opponent No.3 did not tell about this to the complainant. Opponent No.3 told her that if no medicines would be given the virus would remain like this. Then, he said that her husband should take 24 more injections. Then, he went to Jaslok Hospitl and met Dr.Samir Shah. Dr.Shah told him that not a single injection was needed for him. Dr.Shah prescribed some medicines. It took Dr.Sargaokar-opponent No.3 one week to approve all those medicines. Then on 26th August morning patient became unconscious. He was taken to J.J. Hospital. Doctors did not do anything. Again on 18th October he became unconscious and he was taken to J.J. Hospital. Dr.Sargaokar-opponent No.3 admitted him in different Ward where the doctors did not know anything about the case. They suggested opponent No.3 to take advice from Dr.Shah. Then they shifted husband of the complainant to Bombay Hospital on their own risk. He was kept in ICU and in less than 24 hours he became conscious. Dr.Geeta Billa of Bombay Hospital told that, “Pegasys injection not only kills the virus but also kills liver cells”. She told them that due to injections, his liver was decomposed and he would not survive for more than 3 months or one year. He was treated very well. When he became conscious he could not stand or sit on his own because he became very weak. When he returned home he could not walk. He needed someone for safety. Some days he was good, he was improving, but one day cough started and it did not stop. So, she contacted Dr.Geeta Billa. She gave medicines. On 25/12/2004 when he was sleeping he coughed two or three times and passed away. She spent `7-8 Lakhs on his treatment, but he died because of wrong treatment given by the opponent Nos.2&3-doctors. Complainant therefore filed consumer complaint claiming damages of `33,56,000/-. She claimed damages on the basis of monthly salary he was drawing and monthly salary he would have earned if he would have survived upto the age of 60 years. Complainants filed certain papers with the complaint.
4. Opponent No.1 did not contest the matter. Opponent Nos.2&3 filed joint written version. They pleaded that complaint is not tenable and liable to be dismissed with cost. They pleaded that complaint is barred by limitation. They pleaded that there is no negligence or defects in the service rendered by opponent Nos.2&3. They pleaded that Anil Kumar Singh was given proper and required treatment as per the medical standard. Opponent Nos.2&3 submitted that as the patient was diagnosed of chronic active Hepatitis B with compensated liver cirrhosis with portal hypertension, he was advised a course of pegylated interferon alpha 2a injections to be administered weekly. Said course of injections was prescribed in keeping with the treatment guidelines after proper diagnosis, confirmed by laboratory investigations. Opponents pleaded that first injection was given to Anil Kumar Singh on 26/08/2003 in the Ward with uneventful course and further the patient was kept under observation for 3 days and was discharged on 29/08/2003. Opponents denied that opponent No.3 did not listen to the patient’s problems. The very fact that the opponent No.3 told the patient that he was normal (stable) showed that he had carefully listened to the patient and expressed their opinion. They denied that opponent No.3 was informed by the relatives of the patient about any infection on stomach (abdomen). They denied that they had directed the patient to meet Skin Specialist in the OPD. They stated that they had no knowledge about that the patient having gone to Skin Specialist and whether he had prescribed any medicines. They denied that opponent No.3 ignored that the patient’s hands and legs were swelling. In fact when the patient came as outdoor patient, opponent No.3 immediately observed swelling and ascites and advised him Ultra sonography of abdomen and daily Abdominal Girth chart. Accordingly on 19/02/2004 patient got sonography performed which indicated cirrhosis with ascites and therefore, he was admitted on 20/02/2004 for further treatment. They denied that due to effect of injections, liver had decomposed. They have denied that the injection kills cells of liver because virus Hepatitis B is situated inside the liver cells. They denied that after every injection given to the patient, liver had decomposed as alleged by the complainant.
5. They pleaded that patient was informed that in the normal course treatment with pegylated interferon alpha 2a injections is for 48 weekly injections. On 20/02/2004 patient was hospitalized with ascites indicating decompensation of cirrhosis. Looking to the condition of the patient, patient was referred to Dr.Samir Shah of Jaslok Hospital for his expert opinion. Dr.Shah opined that “patient has been given Peg INF monotherapy for six months despite which he had not seroconverted and HBV DNA was still positive”. Dr.Shah opined that the injection given to the complainant was needed. On 09/03/2004 patient was discharged. Opponents denied that opponent No.3 took one week to approve the medicines recommended by Dr.Shah. Opponents pleaded that after 09/03/2004 patient came to J.J. Hospital only on 26/08/2004. Opponents denied that patient was admitted on 26/08/2004 in unconscious condition and he regained conscious on that night and the patient was discharged on 28/08/2004. Opponents denied that Dr.Geeta Billa of Bombay Hospital told the complainant that, “the injection not only kills the virus but also kills the liver cells”. They asserted that Dr.Geeta Billa being qualified medical practitioner would not give such absurd and unscientific opinion. They pleaded that there was no negligence on their part and there is no cause of action for giving any compensation to the complainant and they pleaded that complaint should be summarily dismissed with compensatory costs.
6. Complainant filed an affidavit of her own on 25/10/2010. In her affidavit, she has testified in Para 3 that her late husband was having health problem for almost 2 years prior to August 2003 and when he had symptoms of vomiting, loose motions, abdominal pain and fever, her husband was admitted to J.J. Hospital on 06/08/2003 in Ward No.12-B under the treatment of opponent Nos.2&3. She testified that after examining her husband, opponent No.2-Dr.Alka Deshpande stated that her husband was suffering from chronic active Hepatitis B with compensated liver cirrhosis and PHT and she prescribed injection ‘Pegasys peginterferon alfa-2a’ and she had sent letter to the Central Government Health Scheme telling them that the patient required Pegasys injection once a week for a total of 24 weeks and they should arrange to supply the same. According to the complainant, said 24 injections were given ultimately to her husband from 24/08/2003 for 24 weeks. She asserted that the information provided by the Company manufacturing injection mentioned in the brochure that the patient having Hepatitis-B or severe liver disease should not be given said injection. Ignoring this information, opponent Nos.2&3 gave injection and continued the treatment for 24 weeks and thereby, they were guilty of negligence and they had rendered poor quality of treatment and ultimately, said treatment caused death of her husband. It has come in her affidavit that Dr.Samir Shah of Jaslok Hospital, where her husband’s case was referred to by opponent Nos.2&3, in the first place stated that injections should not have been given to her husband and secondly, the prescription of said steroid tablet had aggravated the condition of her husband. So, she alleged that the opponents played with the health of her husband by giving incorrect treatment. She alleges that she and her relatives insisted that patient should be referred to Jaslok Hospital or Bombay Hospital for better medical care, but the opponent Nos.2&3 declined to do so. But, ultimately, agreed to refer the patient to Dr.Samir Shah of Jaslok Hospital. In her affidavit evidence, she asserted that both the doctors-opponent Nos.2&3 showed utter negligence on their part and they had committed mistake in treating her husband earlier in administering injection and they were trying to avoid their liability. She asserted again and again that the condition of her husband deteriorated to a great extent in as much as his liver had decomposed because of said Pegasys injections and subsequent treatment given in Jaslok and Bombay Hospital could not reverse the permanent damage done to her late husband because of wrong treatment given by the opponents. She asserted that because of this reason, her husband had expired and she, therefore, claimed that both doctors were negligent.
7. In the brochure of “Pegasys (peginterferon alfa-2a) injection”, in fact it has been mentioned that said injection taken alone is a treatment for some people who are infected with Hepatitis B virus. Before starting Pegasys therapy, one has to talk to the healthcare provider about the possible benefits and the possible side effects of treatment to decide if the treatment being administered is right for the patient. It has been mentioned that in taking Pegasys injections, there is risk to pregnancy. In the case of male person, he may have mental health problem, blood pressure and some patients with Hepatitis C and liver scarring can develop sudden severe worsening of their liver disease while taking Pegasys injection. It has been further mentioned that some patients taking Pegasys injection for Hepatitis B have had rise in the blood test that measures liver inflammation and liver condition is required to be watched very closely with additional blood tests. It is stated in this brochure that the Pegasys is a drug used to treat adults who have a lasting (chronic) infection with Hepatitis B virus and who show signs that the virus is damaging the liver.
8. Looking to the brochure supplied to us, we are finding that the Pegasys injection prescribed by opponent Nos.2&3 was must because husband of the complainant was chronic patient, who was suffering from illness from two years and therefore, opponent Nos.2&3 rightly decided to administer Pegasys injection since he was having a lasting or chronic infection with Hepatitis B virus. Pegasys injection reduces the amount of Hepatitis C virus in the body and helps the body’s immune system fight the virus. From the brochure mentioned above, it is clear that the injection prescribed by opponent Nos.2&3 to deceased husband of the complainant cannot be said to be a negligence on their part and there is no other evidence adduced by the complainant. Complainant’s own affidavit is of no use to prove the medical negligence. She should have produced evidence of expert medical witness, but she has not produced anything. As against her own affidavit and the brochure, she is relying upon, we have affidavit of opponent No.2 showing how she treated the patient-deceased husband of the complainant and after investigation she had found that the patient has having HBS+. It was Hepatitis B. Liver biopsy was also got done by Dr.Chitale and there was diagnosis of post Hepatitis Cirrhosis of Liver. Bone marrow biopsy was also conducted and it showed dimorphic (micronormoblastic) erythropoesis. The patient was thus diagnosed as ‘Post Hepatitis Cirrhosis of Liver with viral Cytopathic effect and chronic active Hepatitis B with compensated Liver Cirrhosis with portal hypertension’. In her affidavit, she has stated that she had therefore decided to give Pegasys (peginterferon alfa-2a) injection and since, it was not available, a letter was written to the Central Government Health Scheme and it was mentioned in the letter that patient Anil Kumar Singh was admitted in J.J. Hospital with diagnosis of “Chronic active Hepatitis B with compensated Liver Cirrhosis with Portal Hypertension” and he needed Pegasys injection once in a week for total of 24 weeks and they should make available this life saving drug to the patient. First injection was given on 26/08/2003 with uneventful course and he was discharged on 29/08/2003 and then patient was taking treatment as OPD and he was administered injection Pegasys in the OPD. He was monitored closely and positively in the month of August, October, November & December 2003 and in the month of January & February 2004. On 20/02/2004 patient was hospitalized with ascites with post necrotic cirrhosis. Opinion of Dr.Samir Shah of Jaslok Hospital was taken. Tablet Lamivudin 100 mg. was started. Patient was screened for Hepato Cellular Carcinoma which was negative. Patient had not detected seroconversion. Again patient was admitted on 26/08/2004 in a non-conscious state, but within 4-5 hours he became conscious and he was discharged on 28/08/2004. Again on 18/10/2004 patient was admitted in some other unit of J.J. Hospital. Relatives of the patient took “Discharge against the Medical Advice” and patient was taken to Bombay Hospital. On 25/12/2004 patient died at home and postmortem confirmed that because of liver cirrhosis, patient died. Dr.Deshpande-opponent No.2 in her affidavit in Para 7 clearly stated that the established treatment for cirrhosis is injection Pegasys, Lamivadine and Adefovir. She asserted that 24 Pegasys were given and when no response seen, the patient was kept on Lamivadine and Adefovir. She asserted that complainant’s husband was given proper treatment which is internationally accepted. Lamivadine and Adefovir tablets are having response rate of maximum 32%. She asserted that the treatment of Pegasys injection was proper treatment for chronic active Hepatitis B and C. She asserted that Food & Drug Administration (FDA) had granted permission for the said drug. She asserted that she had taken due care and diligence while making diagnosis of the patient and while giving treatment of Pegasys injections and other tablets as mentioned above. There was no negligence of any kind. She further asserted that patient was discharged on 18/10/2004 against the medical advice and then patient was admitted to the Bombay Hospital. Patient admittedly died at home on 25/12/2004 and postmortem report produced by the complainant showed the cause of death as ‘Cirrhosis’. According to opponent No.2 she had been unnecessarily dragged in this litigation though she was not guilty of any medical negligence. Opponent No.3 also filed detailed affidavit. He also concurred with the affidavit given by Dr.Deshpande-opponent No.2. Opponent No.3 also asserted that the established treatment for liver cirrhosis is ‘injection Pegasys, Lamivadine and Adefovir’. He asserted that after giving 24 Pegasys injections, since no response was found, patient was kept on Lamivadine and Adefovir. He asserted that the patient was given proper treatment which was internationally accepted. He also stated that treatment of Pegasys is a proper treatment for ‘Chronic Active Hepatitis B & C’ and Food & Drug Administration had granted permission for the said drug to be used for the said treatment. He also corroborated with Dr.Deshpande that patient had taken discharge on 18/10/2004 against the medical advice and then patient was taken to Bombay Hospital. After discharge from 18/10/2004 from J.J. Hospital, patient ultimately died on 25/12/2004. Therefore, they did not know what happened to the patient during the period from 18/10/2004 to 25/12/2004. They therefore stated that they had given good treatment. They had taken due and proper care in diagnosing and treating deceased husband of the complainant and they cannot be said to be medically negligent. Opponent No.3 asserted that just to extract moneys from him the complainant has filed this false complaint. Death Certificate issued by Public Health Department suggested that Anil Kumar Singh died of (a) Terminal Cardio respiratory arrest (b) Liver Cirrhosis & (c) Due to Hepatitis B.
9. At page-60 (Exhibit-F) there is a letter issued by Dr.Samir Shah of Jaslok Hospital who clearly mentioned that patient Anil Kumar Singh was referred by Dr.Alka Deshpande on 03/03/2004. He had examined the patient who was having chronic Hepatitis B. HBsAg and HBeAg were positive with high viral load. Liver biopsy showed cirrhosis. He had been given Pegasys injection for six months and despite which he had not seroconverted and HBVDNA was still positive. On examination he found that patient had ascites and he suggested that Lamivudine 100 mg. daily should be given, Lasilac one dose should be given, Steroids should be avoided and he suggested Sonography of Liver with Doppler to rule out HCC development. He had also suggested Gastroscopy. The fact that he had suggested Lamivudine would go to show that said tablet was ultimately given by opponent Nos.2&3. In the circumstances, we are finding that the treatment given to the patient was correct so far as J.J. Hospital treatment is concerned.
10. What is pertinent to note is the fact that the complainant’s husband had taken discharge against the medical advice from J.J. Hospital on 18/10/2004 which proved to be fatal to the complainant’s husband’s health. He was then taking treatment intermittently at Jaslok Hospital and Bombay Hospital. Ultimately, it appears that Bombay Hospital told him to take discharge since his was a case of ‘no symptoms of recovery’ and after he was discharged from Bombay Hospital, ultimately on 25/12/2004 he was died at home. When he died, postmortem was conducted and Indira Gandhi Rural Hospital recorded the cause of death as ‘(a) Terminal Cardio respiratory arrest (b) Liver Cirrhosis & (c) Due to Hepatitis B’. In any view of the matter, we are finding that his was the chronic case of Liver Cirrhosis and Hepatitis B. Doctors at J.J. Hospital had given due and proper treatment after diagnosis. They had also sent the patient to Dr.Samir Shah at Jaslok Hospital and they had started same tablets suggested by Dr.Samir Shah. The fact that the treatment given had not yielded favaourable recovery is not a matter which can be attributed to the medical negligence of both the doctors. The glaring mistake committed by complainant and her relatives is that she had taken discharge of her husband on 18/10/2004 from J.J. Hospital against the medical advice and that proved to be fatal. She was pleased to keep her husband at her home itself where he died on 25/12/2004. In this view of the matter, we are finding that there is virtually no case of medical negligence proved by the complainant as against J.J. Hospital as also against opponent Nos.2&3-doctors. Complaint appears to be absolutely false and frivolous. In the circumstances, we pass the following order :-
-: ORDER :-
1. Consumer Complaint stands dismissed.
2. No order as to costs.
3. Copies of the order be furnished to the parties.
