On 4.6.1991, the blood culture report of the respondent was received, which showed a serious infection of the blood stream staphylococcus species .
On 29.5.1991, the companyplainant was in a serious companydition having high fever of 104OF.
Urine analysis was also carried out which showed the presence of bacteria.
The National Commission held that the cause of cardiac arrest was intravenous injection of Lariago of such a high dose.
The appellant was of the view that the respondents infection companyld only be treated by injection of Amikacin, as Methenamine Mandelate companyld number be used due to his chronic renal failure.
The facts of the case reveal that the respondent was suffering from chronic renal failure and was undergoing haemodialysis twice a week on that account.
In Nihal Kaur vs. Director, P.G.I.M.S.R. 1996 CPJ 112 a patient died a day after surgery and the relatives found a pair of scissors utilized by the surgeon while companylecting the last remains.
Since Methenamine Mandelate cannot be used in patients suffering from renal failure, Amikacin injection was administered to him.
The case of the appellant, however, is that the companyplainant was referred to the appellant by Dr. F. P. Soonawalla, the renowned Urologist of Bombay.
Amikacin was administered on 5th, 6th and 7th June, 1991 and at this stage he did number companyplain of any side effects and his temperature subsided rapidly.
On 11.6.1991, the respondent attended the Haemodialysis Unit and companyplained to the appellant that he had slight tinnitus ringing in the ear .
Augmentine 375 mg 3 times a day for 6 weeks for blood infection Cap.
In Consumer Protection Council and Others vs. Dr. M. Sundaram and Another 1998 CPJ 3, the facts were that one Mrs. Rajalaxmi was admitted to a nursing home which diagnosed the ailment as Hodgkins Lymphoma.
Blood Urea 180 mg and Haemoglobin 4.3 which was 5 days prior to the companymencement of the injection Amikacin and number after the said injection.
Subsequently she was discharged from the nursing home and was advised to visit CMC Vellore for treatment.
Thus, until 20th June, 1991, the said Mohd.
Heard learned companynsel for the parties and perused the record.
Augmantine because of tinnitus as early as on 11.6.1991.
In Dr. Suresh Gupta vs. Government of N.C.T. of Delhi and another AIR 2004 SC 4091, the appellant was a doctor accused under Section 304A IPC for causing death of his patient.
Consequent upon the treatment, the temperature of the respondent rapidly subsided.
The said Mohd.
Two affidavits by way of evidence were filed on behalf of the respondent, being that of his wife and himself.
Amikacin was prescribed to him only after obtaining blood and urine culture reports on 3rd and 4th June, 1991, which showed the respondent resistant to other antibiotics.
The respondents report also established his resistance to all other antibiotics.
Ishaq came to the said hospital as an outdoor as well as indoor patient for Haemodialysis on a number of occasions companymencing from the month of April, 14th 1991 till 20th June, 1991 till 8th June, 1991 until suo moto he left the hospital.
twice a day.
Becosule tab daily Tab.
Hence the appellant suggested to the companyplainant to have Haemodialysis twice a week as an outdoor patient.
Folvite 1 tab.
The State Commission found that necessary precautions and effective measures were taken to save the deceased and dismissed the companyplaint.
The doctor was held liable and a companypensation of Rs.1.20 lakhs was awarded by the State Consumer Forum, Chandigarh.
The Magistrate who charged the appellant stated in his judgment that the appellant while companyducting the operation for removal of the nasal deformity gave incision in a wrong part and due to that blood seeped into the respiratory passage and because of that the patient companylapsed and died.
The report showed severe urinary tract infection due to Klebsiella species 1 lac ml.
The companyplainant had companysulted Dr. F. P. Soonawalla who had referred the companyplainant to the appellant for routine Haemodialysis and pre transplant treatment.
The appellant has alleged in his written statement filed before the National Commission that the companyplainant was in a hurry to have a quick kidney transplant by Dr. Soonawalla and he was very obstinate, stubborn and short tempered.
On 5.6.1991, he was administered Cap.
On 30.7.1991, the respondent was operated upon for transplant after he had ceased to be under the treatment of the appellant.
She had suffered a massive heart attack while in the operation theatre.
The companyplainant was also investigated to find a suitable kidney donor.
After examining the companyplainant, the appellant found that the companyplainant was a patient of Chronic Renal Failure due to Bilateral Poly Cystic Kidneys.
The companyplainant was investigated on 30.5.1991 and his report showed High Creatinine 13 mg.,
Nothing abnormal was found in him.
After much persuasion he finally agreed to be admitted for final investigation and got admitted in the hospital on 29.5.1991.
The appellant once again immediately advised him urgent admission to the said hospital which the respondent refused to companyply and said that he would go elsewhere.
On the companytrary, he used to have companyversation and used to respond to the same as an ordinary man.
The appellant has alleged that the said opinion was written without examining the respondent and, in any case, the appellant was number afforded an opportunity of cross examining the person who gave the opinion.
The following chart indicates the results of the study in companyparison to the numbermal range Normal Range Creatinine 13.0 mgs.
On 20.5.1991, the companyplainant approached the appellant with high fever of 101 103OF, and the appellant suggested immediate admission of the companyplainant in the hospital for detailed investigation and treatment but the companyplainant refused to get himself admitted and refused to companyply with the advice.
On 30.5.1991, the respondent was investigated for typhoid fever, which was negative.
blood urea 180 mg.
He was suffering from high fever which remained between 1010 1040F. He refused to get admitted to hospital despite the advice of the appellant.
On 5.6.1991, Amikacin injection was administered to the respondent for three days from 5th to 7th June, 1991 , since the urinary infection of the respondent was sensitive to Amikacin.
was administered three times a day for the blood infection and the respondent was transfused one unit of blood during dialysis.
Augmentin 375 mg.
A perusal of the companyplaint filed by the respondent before the National Commission shows that his main allegation is that he suffered hearing impairment due to the negligence of the appellant herein who allegedly prescribed overdose of Amikacin injections without caring about the critical companydition of the respondent which did number warrant that much dose.
The patient companysulted another doctor who diagnosed the same as renal failure.
The National Consumer Disputes Redressal Commission hereinafter referred to as the Commission passed an order on 6.10.1993 directing the numberination of an expert from the All India Institute of Medical Sciences, New Delhi AIIMS to examine the companyplaint and give an opinion.
On 13.8.1991, the respondent was discharged from Prince Aly Khan Hospital after his transplant.
The said Mohd.
Augmantine verbally, and also marked X on the discharge card in his own hand writing on 11.6.1991 i.e. 3 days after discharge.
Thereafter the respondent did number companye to the hospital.
However, during Haemodialysis, he companyplained to the Doctor of ringing in the ears and thereupon Dr. Martin DSouza called for the Discharge Card of the said Mohd.
The respondent returned to Delhi on 14.8.1991, after discharge.
11.5 13.5 gms.
On or about 24.4.1991, the respondent reached Nanavati Hospital, Bombay and was under the treatment of the appellant Doctor.
She was administered Endoxan injection five doses in five days.
This was done in order to get an unbiased and neutral opinion.
Investigations were underway to find a suitable donor.
Methnamine Mandelate cannot be used in patients suffering from renal failure.
The appellant advised the respondent in view of his blood infection that he should number get transplanted for six weeks, but the companyplainant respondent insisted on getting the transplant although he was number medically in fit companydition.
The appellant submitted before the Commission that at the time of admission of the respondent on 29.5.1991 to the hospital, he had fever of 1040F and, after investigation, it was found that his serum creatinine level was 13 mg, blood urea 180 mg and Haemoglobin 4.3 mg.
The appellant filed his reply stating, inter alia, that there was numbermaterial brought on record by the respondent to show any company relationship between the drugs prescribed and the state of his health.
In this situation, the appellant was left with numberchoice but to suggest Injection Amikacin 500 mg twice a day in view of the respondents infection and delicate companydition and his refusal to visit the Haemodialysis facility on alternate dates.
He was offered a seat in B.E. Degree companyrse in four Engineering Colleges.
On 8.6.1991, the respondent, despite the appellants advice, got himself discharged from Nanavati Hospital.
There was clear dereliction of duty on the part of the nurse who was number even a qualified nurse and was number registered with any nursing companyncil of any State.
Daily Syrup Alludux Injection Engrex once a month for 2 months Cap.
Augmentin 375 mg three times a day for his serious Blood Infection and he was also transferred one Unit of Blood during dialysis and his temperature subsided rapidly and he felt much better.
Certain other drugs were also specified to be taken under the supervision of the appellant when he visited the Dialysis Unit.
On 14.6.1991, 18.6.1991 and 20.6.1991 the respondent received haemodialysis at Nanavati Hospital and allegedly did number companyplain of deafness during this period.
He had a minor ailment chronic nasal discharge for which his mother took him to a doctor for companysultation who diagnosed the disease as Nasal Allergy and suggested operation for removal of tonsils.
In our opinion it is clear that the respondent already had high Blood Creatinine, Blood Urea and low Haemoglobin before the injection of Amikacin.
Hence the appellant was obliged to put the companyplainant on a Broad Spectrum Antibiotic Ampoxim 500 mg four times a day and Tab.
Haemoglobin 4.3 gms.
I distinctly remember him, as very few patients are as ill tempered arrogant and obstinate like him.
The medical report showed high creatinine 13 mg.,
At that time, his fever remained between 1010 1040F. The appellant companystantly requested the companyplainant to get admitted to hospital but the respondent refused.
She was referred to another doctor who was an ENT specialist, who after examination opined that numberlymph glands were seen.
0.7 1.5 mgs.
Thereafter, the appellant was number under the treatment of the appellant.
I say that after 11th June, 1991, the said Mohd.
He had also high fever which was on account of serious blood and urinary tract infection.
He was also investigated for ESR, which was expectedly high in view of renal failure and anemia infection.
From 20.5.1991 to 29.5.1991, the respondent attended the Haemodialysis Unit at Nanavati Hospital on three occasions.
On 29.5.1991 the respondent who had high fever of 1040F finally agreed to get admitted to hospital due to his serious companydition.
On 3.6.1991, the reports of the urine culture and sensitivity were received.
Ishaq and his wife who had accompanied him, number to take or get administered the said injection.
The operation performed by him was for removing his nasal deformity.
It is also the case of the respondent that the infection he was suffering from was number of a nature as to warrant administration of Amikacin to him.
The Haemoglobin of the respondent was 4.3.
There was vacuum slip, and the baby was delivered in an asphyxiated companydition.
Ishaq came to the hospital as an outdoor patient on 14th June, 17th June and 20th June, 1991 and did number make any companyplaint of any nature whatsoever with regard to his hearing faculties.
10 50 mgs.
Dr. Soonawalla was out of India from 1.6.1991 to 1.7.1991.
In P.N. Rao vs. G. Jayaprakasu AIR 1990 AP 207, the plaintiff was a brilliant young boy who had passed the pre University companyrse securing 100 marks in Mathematics and 93.5 in physical sciences.
In Spring Medows Hospital Another vs. Harjol Ahluwalia thr K.S. Ahluwalia Another 1998 CPJ 1, a minor child was admitted by his parents to a nursing home as he was suffering fever.
These were of the appellant himself, Dr. Danbar a doctor attached to the Haemodialysis Department of Nanavati Hospital , Dr. Abhijit Joshi a Resident Senior Houseman of Nanavati Hospital , Mrs. Mukta Kalekar a Senior sister at Nanavati Hospital , Dr. Sonawala the Urologist who referred the respondent to the appellant and Dr. Ashique Ali Rawal a Urologist attached to Prince Aly Khan Hospital .
Hence the appellant advised the respondent to further stay in the hospital for some time, but the respondent did number agree and he started shouting at the top of his voice and insisted to be discharged from the hospital on his own on 8.6.1991 at 9 a.m In view of his insistence the respondent was discharged from the hospital on his own on 8.6.1991 at 9 a.m The appellant suggested alternate day Haemodialysis but the respondent refused saying that he was staying too far away and companyld number companye three times a week for Haemodialysis.
He had companye of his own and he had numberproblem either in walking or in hearing.
Augmentin and put a cross against the prescription of the said injection, and immediately gave instructions to me as well as to the other staff members number to give that injection at all, and also told the said Mohd.
Cases, both civil and criminal as well as in Consumer Fora, are often filed against medical practitioners and hospitals, companyplaining of medical negligence against doctors hospitals nursing homes and hence the latter naturally would like to know about their liability.
However, despite express instructions from the appellant, the respondent companytinued to take Amikacin till 17.6.1991.
Ishaq used to companye to hospital on his own without the assistance or help of anybody and after the dialysis also he used to go on his own.
The appellant also suggested the following drugs under the supervision of the doctor when he would visit the dialysis unit Injection Amikacin 500 mg twice a day x 10 days for urinary tract infection.
Ishfaq ii The wife of the respondent iii Dr. Ashok Sareen iv Dr. Vindu Amitabh On behalf of the appellant, six affidavits by way of evidence were filed.
Ishaq and verified the medicine and injections which were prescribed and on verification, Dr. Martin F.DSouza immediately deleted injection Amikacine and Cap.
On 25.6.1991, the respondent, on his own accord, was admitted to Prince Aly Khan Hospital, where he was also treated with antibiotics.
From 5.6.1991 to 8.6.1991, the respondent insisted on immediate kidney transplant even though the respondent had advised him that in view of his blood and urine infection numbertransplant companyld take place for six weeks.
Bantes 100 mg twice a day It appears that the respondent attended the Haemodyalsis unit where he met the appellant on 11th, 14th, 18th and 20th June, 1991.
The companyplainant respondent herein has alleged that due to this medical negligence the companyplainant has suffered mental torture and frustration and other signs of helplessness and is feeling totally handicapped, and his efficiency in office has got adversely affected.
Rejoinder was filed by the respondent.
He did number regain companysciousness even after three days and thereafter for another 15 days he was number able to speak companyerently.
Evidence was thereupon led before the Commission.
Since the respondent was suffering from blood and urinary infection and had refused to companye for haemodialysis on alternate days, the appellant suggested Injection Amikacin 500 mg.
Both the doctor and nurse and the hospital were found liable and Rs.12.5 lakhs was awarded as companypensation to the parents.
A sample of her bone marrow was sent to an Oncologist who opined that the picture does number fit with Hodgkins disease but the patient had megaloblastic anemia in the bone marrow.
On 7.7.1992, the respondent filed a companyplaint before the National Consumer Disputes Redressal Commission, New Delhi being Original Petition No.178 of 1992 claiming companypensation of an amount of Rs.12,00,000/ as his hearing had been affected.
The case of the respondent, in brief, is that the appellant was negligent in prescribing Amikacin to the respondent of 500 mg twice a day for 14 days as such dosage was excessive and caused hearing impairment.
At the time, the respondent, who was suffering from high fever, did number want to be admitted to the Hospital despite the advice of the appellant.
The respondent wanted to be operated by Dr. Sonawala alone who was out of India from 1.6.1991 to 1.7.1991.
On 20.5.1991, the respondent approached the appellant Doctor.
Hence, a broad spectrum antibiotic was prescribed to him.
At that stage, the respondent was undergoing haemodialysis twice a week on account of chronic renal failure.
Blood Urea 180 mgs.
When he was discharged from hospital, he companyld only utter a few words and companyld number read or write and lost all his knowledge and learning.
It was held on the basis of medical opinion that any prudent companysultant physician would number delay the companymencement of chemotherapy where repeated examination of the bone marrow slides had yielded the report that the Hodgkins deposits were present.
The doctor was negligent in performing his duty because instead of administering the injection himself he permitted the nurse to give the injection.
His father took him to Vellore where he was examined by a Professor of Neuro Surgery and it was found that his brain had suffered due to cerebral anoxia, which was a result of improper induction of anaesthetics and failure to take immediate steps to reduce anaesthesia.
Hence, as per direction of the appellant the respondent should have stopped receiving Injection Amikacin after 10.6.1991, but on his own he kept on taking Amikacin Injections.
The witnesses for the appellant were The appellant Dr. M.F. DSouza ii Dr. Danbar iii Dr. Upadhyay iv Mrs. Mukta Kalekar Dr. Ashique Ali Rawal The respondent also filed an opinion of the Chief of Nephrology at Fairview General Hospital, Cleveland, Ohlo, which was heavily relied upon in the impugned judgment.
He was admitted in the Government General Hospital, Guntur and the operation was performed.
The witnesses for the respondent were The respondent Mohd.
The brief facts of the case are narrated below In March 1991, the respondent who was suffering from chronic renal failure was referred by the Director, Health Services to the Nanavati Hospital, Mumbai for the purpose of a kidney transplant.
The report also showed that the infection companyld be treated by Amikacin and Methenamine Mandelate and that the infection was resistant to other antibiotics.
Gastroscopy was done on 4.6.1991 and Amikacin was administered after test dosage only from 5.6.1991.
He was also getting a monthly scholarship.
The appellant again advised the companyplainant to get admitted in hospital, but he refused the advice on account of his obstinacy.
A nurse asked the father of the patient to get an injection Lariago which was administered by the nurse to the patient who immediately companylapsed.
The appellant prescribed antibiotics for him.
The companyplainant allegedly did number companyplain of deafness during this period and companyversed with doctors numbermally, as is evident from their evidence.
On 11.6.1991 the respondent companyplained to the appellant of slight tinnitus or ringing in the ear.
The appellant has alleged that he immediately told the respondent to stop taking the Amikacin and Augmentin and scored out the treatment on the discharge card.
On 30.5.1991 the respondent was investigated for renal package.
The appellant immediately reviewed the treatment on the discharge card in possession of the respondent and asked the said respondent and also asked his attendant i.e. his wife to stop Injection Amikacin and Cap.
The companyplainant alleged that the first doctor failed and neglected to refer the matter to a Cancer Specialist but wrongly diagnosed the ailment of the patient as Hodgkins Lymphoma and had unnecessarily administered injection of Endoxan and because of the toxicity of that drug the kidney cells of the patient got destroyed resulting in renal failure for which she had to undergo kidney transplantation which led to her death.
On these facts the Supreme Court held that the doctor was liable to pay damages to the parents of the boy.
Ishaq came to the hospital for the purpose of Haemodialysis.
MARKANDEY KATJU, J. This appeal against the judgment of the National Consumer Disputes Redressal Commission, New Delhi dated 22.3.2002 has been filed under Section 23 of the Consumer Protection Act, 1986.
The patient was admitted and the doctor diagnosed typhoid and gave medicines for typhoid fever.
In Sethuraman Subramaniam Iyer vs. Triveni Nursing Home and Another 1998 CPJ 110, the companyplainants wife suffered from Sinusitis and was advised surgery by the doctor.
I say that on 11th June,1991 the said Mohd.
The Discharge Card as per the respondents companyplaint clearly shows that the said injection had been X crossed, and he was directed number to take the said injection from 11.6.1991 i.e. on his very first companyplaint when he made mention of ringing in the ears or tinnitus.
On perusal of the Xerox companyies of the papers of the Cash Memo supplied by the respondent as per annexure 4 it is in our opinion evident that the respondent companytinued to take the medicine against the advice of the appellant, and had unilaterally been getting injected as late as 17.6.1991, i.e. 7 days after he had been instructed verbally and in writing in the presence of his attendant i.e. his wife and staff members of the said hospital to stop Injection Amikacin Cap.
It may be mentioned that the respondent is working as Export Promotion Officer in the Ministry of Commerce, Udyog Bhawan, New Delhi.
From 21.5.1991, the companyplainant attended the Haemodialysis unit of the hospital on three occasions and informed the appellant that the fever had number yet remitted.
Crocin SOS fever.
The respondent was also suffering from severe urinary tract infection which companyld only be treated by Amikacin or Methenamine Mandelate.
The doctor was examined and testified that the child suffered a cardiac arrest on account of the medicine having being injected which led to brain damage.
