DR. S. M. KANTIKAR, MEMBER
1. Sh. Dauj Dayal Chauhan, the complainant, admitted his wife, Smt. Kamlesh Kumari Chauhan, since deceased, (hereinafter referred as ‘patient’) in Swarn Jayant Samudaik Hospital, OP 1, on 24.3.2000. Patient was suffering from fever. Dr. A. Asthana, OP 3, diagnosed her as a case of PUO ‘Pyrexia’, which is a type of Psychiatrist disease and started treatment. After three days i.e. on 27.3.2000, she was discharged from OP hospital at 9.00 p.m. Thereafter, the condition of patient deteriorated. Therefore, she was re-admitted in the hospital/OP 1, on 28.3.2000. Dr. Asthana did not visit or examine the patient personally, but suggested medicines to the patient from his residence. On 29.3.2000, OP-3 referred the patient to Dr. Tandon. Thereafter, day by day, the patient’s condition went on deteriorating. On 30.3.2000, the doctors of said hospital advised the complainant to take the patient for psychiatric consultation. Therefore, the complainant shifted his wife to Agra and consulted Dr. H. B. Singh (Psychiatric) at Madiakatra, Agra. The patient was taken to Agra Hospital in the Ambulance of OP 1. On seeing the report of CSF, Dr. H. B. Singh opined that, it’s a case of meningitis and not a case of psychiatric disease. Therefore, he referred the patient for further treatment to Dr. Rakesh Aggarwal, Neurologist at Delhi Gate, Agra. Dr. Rakesh Aggarwal also confirmed that it was the case of meningitis. Therefore, looking to the seriousness of the patient, he admitted the patient at Siddhartha Hospital at Agra. He confirmed meningitis by CT scan. Subsequently, on 31.3.2000, the patient expired at 6.00 p.m. in Siddharth Hospital, Delhi Gate, Agra. Therefore, the complainant alleged that due to initial wrong diagnosis and wrong treatment by the doctors of OP 1, the patient did not improve, which resulted into death of patient.
2. The complainant further submitted that his wife was a LL.B. graduate and practising in 1994, as a lawyer. She was earning about 6000/- per month. Also, she was completing LL.M. Due to untimely death, the family suffered severe loss, financially as well as morally. Therefore, the complainant filed this complaint before this Commission and prayed for total compensation of Rs. 30 lakhs from OP and suspension of licence of Dr. Asthana and Dr. Tandon.
3. The OPs resisted the complainant by filing written version and affidavit evidence. OPs specifically denied that the doctors did not diagnose or give proper treatment from 24.3.2000 to 30.3.2000. The OP diagnosed it as a case of “Pyrexia of unknown origin (PUO)”, which is a kind of infection and fever of unknown origin. However, the complainant is misleading the Commission that PUO is a type of “Psychiatric Disease” only to extract money. The patient was treated for infection, which later on was diagnosed as meningitis infection. The treatment given by the doctors in the hospital was as per standard practice and correct. The copies of the relevant medical extracts are Exhibit-DW/1. The PUO or synonymous as Fever of Undetermined origin (FUO) is not a psychiatric disease. Thus, it was a misinterpretation that the patient was given psychiatric treatment. The basic premise of the complainant was that patient was wrongly treated for PUO. The CSF report dated 24.3.2000 was not conclusive evidence of meningitis. On admission to the hospital, OP-3 Dr. Asthana, properly examined the patient and suspected it as a case of Meningitis/Encephalitis/ Enteric Encephalopathy. Therefore, proper treatment was started with higher antibiotics like inj. Monocef, Metrogyl 100 ml etc. Also, IV Manitol 20% under 100 ml l/v was given every 12 hourly. The patient stayed in the hospital, till 27.3.2000. The patient was again readmitted in the hospital under Dr. Asthana, on 29.3.2000 at 1:00 hours. The patient was reviewed by Dr. Asthana and referred to his colleague Dr. M.K. Tondan, who is a Neurosurgeon. Dr. Tondan examined the patient and advised few investigations and continued same treatment as prescribed by Dr. Asthana, thus, it was not psychiatric treatment. Dr. Tondan asked for review of X-Ray of dorsolumbar spine, MRI scan of lumbosacral segment of spinal cord and adjoining dorsal cord. CT scan of head, to rule out tumor, called Ependymoma. The OPs specifically denied that on 30.3.2000, the doctors of OP hospital advised the complainant that it was a case of psychiatric. The patient was transferred to Agra for consultation as the specialist was not available at OP hospital. There was no deficiency of service on the part of OP 1 and 2 or on the part of hospital, in any manner. Dr. Asthana and Dr. Tondan, both wanted the patient to be referred to a higher centre in Agra, for assessment, as the patient had been ill for a long time i.e. more than 1 ½ months. It is specifically denied that the doctors of the hospital were incompetent and careless. The report of CSF test was done at OP, on 24.3.2000, marked as Annexure R-4 (colly), was not conclusive evidence of meningitis. OP 1 and 2 considered possibility of meningitis as one of the cause of PUO, proper investigations were carried out, including CSF analysis. Report of the CSF was not clearly indicating meningitis. It might have resulted from previous medication, which the patient took for 1 ½ months, which patient concealed at the time of admission and thereafter. As it was a case of suspected meningitis, full and proper treatment for meningitis was given. (annexure-R-4). It is wrong and denied that Meningitis can be confirmed merely by CT Scan only, but the CSF is a confirmatory test to diagnose meninigitis. .
4. The learned counsel for complainant vehemently argued the matter and reiterated the submissions made in the complaint. He brought our attention to the relevant medical record, discharge summery and referral slip given by OP. Patient was not discharged LAMA, it was referred to the Agra for psychiatric opinion. He submitted that, the OP1 and 2 failed to diagnose the case as meningitis and wrongly treated. It was a gross negligence on the part of OPs.
5. The learned counsel for the OP argued on legal points that, the hospital is run by NIRPHAD, which is established under the orders of Hon’ble Supreme Court of India, on non-profit motive. Therefore, the complainant is not a consumer. The complaint is barred by time and the complainant amended the complaint for enhancement i.e. from Rs. 2 lakhs to 20 lakhs, such amendment is barred by time. The complaint is deliberately filed which is an abuse of the process of law and misleading this Commission.
6. The counsel for OPs denied that the doctors of the hospital were incompetent and careless at the time of treating the patient. He denied that, the doctors in OP hospital failed to diagnose and give proper treatment to the patient from 24.3.2000 to 30.3.2000. The patient was suffering from fever for 1 ½ months, the record of which was not made available to the doctors at the time of admission. The patient was diagnosed as PUO, not a psychiatric disease which, later on, was confirmed as meningitis. The opinion of Dr. H.B. Singh is not available to support the contention of the complainant. Further, as per prescription of Dr. Rakesh Agarwal of Delhi Gate, Agra, he is a neurosurgeon( not a neurologist) He did not diagnose it as a case of meningitis , but he used query (?) indicating that the diagnosis was not clear.
Findings and Discussion:
7. We have perused the medical records, referral slip, discharge summery and the relevant medical text from books on medicine, neurology. As a factual situation, the patient was suffering from fever since 1 ½ month and vomiting for 3-4 days. She was admitted to Swaran Jayanti Samudaik Hospital (OP-1) on 24.3.2000 at 10:05 A.M. She was diagnosed as a patient of pyrexia of unknown origin (PUO). After examination by Dr.Ashtana (OP-3)., the provisional diagnosis made was ?Meningitis, ?.. Encephalitis ? Enteric Encephalopathy. The treatment was given by antibiotics, antipyretics and mannitol. In our view, patient was treated properly for meningitis, which is also one of the causes of PUO. The treatment was not for psychiatric disease. It should be borne in mind that, pyrexia is not a psychiatric disease.
8. The relevant medical texts regarding PUO, is defined as under:-
- Temperature greater than 38.3 C (101F) on several occasions.
- Duration of fever for more than 3 weeks.
- Failure to reach a diagnosis, despite 3 outpatients’ visits or 3 days in Hospital.
9. In a prospective case series of 199 consecutive cases of PUO patients, it was subsequently found that the cause of PUO was:-
- Infections – 22.5%
- Tumours -7%
- Non-infectious inflammatory disease-23%
- Miscellaneous -21-5%
10. As per literature, 22 % of PUO cases presented due to infection, meningitis is a type of infection. Therefore, the treatment given by OP was for infection, i.e correctly treated.
11. In our considered view, the patient was a frank case of meningitis, the OP-3, suspected the casue of PUO as meningitis. Patient was initially treated from 24.3.2000, till her discharge, on 27.3.2000. She was brought again, on 28.3.2000, for fever and pain in abdomen. Oral medicines were given. She was again re-admitted on 29.3.2000, in midnight. The OP doctor examined her. The condition of patient was critical, therefore, she was referred for psychiatric opinion to S. N. Medical College, Agra. There, Dr. Rakesh Agarwal, a Neurosurgeon, confirmed it as a case of meningitis.
12. We put more reliance upon few judgments of Hon’ble Supreme court. In V.Kishan Rao vs. Nikhil Super Speciality Hospital, (2010) 5 SCC 513, and Dr Laxman B. Joshi Vs Dr.Trimbak Bapu Godbole & anr 969 0 AIR (SC) 128 it was held that,
The duties which a doctor owes to his patient are clear. A person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a person when consulted by a patient owes him certain duties, viz., a duty of care in deciding whether to undertake the case, a duty of care in deciding what treatment to give or a duty of care in the administration of that treatment. A breach of any of those, duties gives a right of action for negligence to, the patient. The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law require: (cf. Halsbury's Laws of England 3rd ed. vol. 26 p. 17).
13. In Achutrao Haribhau Khodwa & Others v. State of Maharashtra & Others (1996) 2 SCC 634, this Court noticed that,
“in the very nature of medical profession, skills differs from doctor to doctor and more than one alternative course of treatment are available, all admissible. Negligence cannot be attributed to a doctor so long as he is performing his duties to the best of his ability and with due care and caution. Merely because the doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chosen by him was acceptable to the medical profession.
14. In the instant case, the OP doctors initially diagnosed the patient as PUO and suspected the cause of PUO as Meningitis/Encephalitis or enteric encephalopathy. OP-3 administered proper treatment for meningitis by use of antibiotics and Mannitol. The referral of patient to Agra, cannot be taken as negligent refererral. The patients of suspected meningitis show neurological signs, which are similar to psychosis also. We do not find any cogent evidence that, OP treated the patient wrongly. Moreover, patient and the complainant concealed the 1 ½ months past history of fever, which would have helped the treating doctor to take proper decisions.
15. The OPs acted in accordance of standard of practice. In this context, we viewed the landmark judgment of Hon’ble Supreme Court which came in rescue of doctors that in case Kusum Sharma & Others Vs. Batra Hospital & Medical Research Centre & Others (2010) 3 SCC 480; the bench comprising Hon’ble Justices Dalveer Bhandari and H S Bedi, dismissing a complaint held that, Consumer Protection Act (CPA) should not be a "halter round the neck" of doctors to make them fearful and apprehensive of taking professional decisions at crucial moments to explore possibility of reviving patients hanging between life and death." Also said that “Doctors in complicated cases, have to take chance, even if the rate of survival is low. A doctor faced with an emergency, ordinarily tries his best to redeem the patient out of his suffering. He does not gain anything by acting with negligence or by omitting to do an act,” It further observed as, "It is a matter of common knowledge that after some unfortunate event, there is a marked tendency to look for a human factor to blame for an untoward event, a tendency which is closely linked with the desire to punish.”
16. In the entirety, we do not find any negligence caused by the OPs during treatment of the patient. Complainant’s perception about Pyrexia of Unknown Origin (PUO) as a Pyschatric disease is wrong. Therefore, we do not see any merit in the instant complaint, hence it is dismissed.