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Case of death due to sudden cardio-respiratory arrest while being treated for schizophrenia

(Source: Sow.Induma Krishnarao … vs Dr.UlhasBendale, on 30 October, 2009. Available at: h ps://indiankanoon.org/doc/137673866/. Accessed on: September 27, 2019).

Summary

The present case was filed by the complainant against the respondent for failure to exercise due care, skill and competency which led to the demise of her son. The complainant Mrs. A had admi ed her 23-year old son in the respondent`s hospital on 13.2.1986 for treatment of stress. The respondent examined the pa ent and found it to be a case of schizophrenia. He therefore decided to give treatment of ECT (Electro Convulsive Therapy) and an psycho cs. The complainant alleged that the respondent had administered electric shocks to the pa ent despite her opposi on. However, respondent stated the he had obtained wri en consent for administering ECT from the pa ent’s father. A er the administra on of ECT, pa ent was moved to a special room and an psycho c therapy was started. The pa ent was examined every day by the respondent. He again administered ECT to the pa ent under general anesthesia. The pa ent’s condi on was normal up to 20.2.1996. He was kept in a special room, at around 5:30 a.m. the staff tried to awake him but he did not respond. Hence, respondent was called. He started cardio respiratory resuscita on up to 5.50 a.m. but his efforts were in vain. Thus he declared the pa ent dead at 5.50 a.m. Cause of death was sudden cardio respiratory arrest. The respondent put forth an excerpt from Modern Synopsis of Comprehensive Textbook of Psychiatry/III, II Edi on, which states that pa ent can die due to sudden cardio respiratory arrest while trea ng for schizophrenia. Thus he determined cause of death as Sudden Cardio Respiratory Arrest. The complainant was not ready to accept the death of her son. She therefore approached the Commission demanding compensa on of Rs. 15 lakhs.

Despite of making the complaint, the complainant could not produce enough evidence to support their allega ons. The complainant could not establish any negligence on the part of the respondent. Therefore, the commission stated that since the complainant had failed to prove any deficiency in service on the part of opposite par es in the ma er of his treatment, the complaint has to be dismissed.

Ÿ The complainant Mrs. A had admi ed her 23-year old son in the respondent`s hospital on 13.2.1986 for treatment of stress.

Case of the complainant

Ÿ  TherespondentDr.Xgavehimelectricshocktreatmentwithoutherconsent.

Ÿ  Despite her opposi on for the treatment, the respondent administered electric shocks to the pa ent
first on 13.2.1996, second on 14.2.1996 and third on 19.3.1996.

Ÿ  Thepa entwasalsoprescribed12tabletsperday.

Ÿ  The complainant further stated that her son was facing breathing problem, and when she asked the respondent about it, respondent ignored her requests to intervene.

Ÿ  She had tried to feed him water but he did not consume. Thus respondent was called and he declared the pa ent dead. She stated that he was alive at that me.

Ÿ  She requested respondent to call some other doctors, but he repeatedly ignored her requests.

Ÿ  She further stated that she was by the respondent’s staff and given two injec ons.

Ÿ  TherespondentNo.1hadaskedthepeopleinthehospitalnot to gather near pa ent.

Ÿ  Itwascontendedthatthepa entdiedat3.00a.m.on21.2.1996.Theanesthe starrived1to11⁄2hours a er the pa ent was already expired.

Ÿ  Thecomplainantstatedthatshehadadmi edhersonwithcomplaintsofstressandnothingelse.

Ÿ  Thedeadbodyofthepa entwashandedovertothemat11.30a.m.on22.2.1996.

Ÿ  It was contended that the pa ent was just 23 years old. He was doing B.Sc. and was working as a Professor in Nursing Centre at Wardha.

Ÿ  The complainant approached State Consumer Dispute Redressal Commission demanding compensa on of Rs.15 lakhs.

  

Case of the respondent:

Ÿ  Respondent No.1 appeared before the commission and resisted the complaint by filing his wri en statement.

Ÿ  He stated that he was prac cing as a psychiatrist at Jalgaon since January 1978 and had treated numerous cases of Schizophrenia.

Ÿ  The complainant bought her son on 13.2.1996 at 10.30 a.m., to him. He examined him and found that it was a case of Schizophrenia.

Ÿ  Heexaminedhimthoroughlyandfoundthathehadnootherdisease.

Ÿ  HedecidedtogivetreatmentofECT(ElectroConvulsiveTherapy)andan psycho cs.

Ÿ  It was contended that he had given detailed informa on about electric shock and had obtained wri en consent for administering ECT from the pa ent’s father.

Ÿ  It was contended that he administered ECT without anesthesia on 13.2.1996, following which the pa ent became conscious within 15 to 20 minutes. Therea er he was moved to special room.

Ÿ  The respondent started an psycho c therapy from 13.2.1996. He prescribed tablet Relicalm Fort-1, Tvdol 1.5 mg-1, Amitol 50 mg-1, nitrozap 5 mg -1.

Ÿ  The respondent used to examine the pa ent every day at 5.00 p.m. and used to take decision about the treatment.

Ÿ  The respondent administered ECT again on 15.2.1996 and 19.2.1996 under general anesthesia.

Ÿ  The respondent observed that the pa ent spiked a fever on 16.2.1996 and also had sour throat for which he was prescribed with syfrodec 500 mg.

Ÿ  It was contended that his condi on was normal up to 20.2.1996.

Ÿ  It was contended that the pa ent was in special room from 10.00 p.m. to 5.30 a.m. At 5.30 a.m. staff tried to awaken him but he did not respond and thus the respondent was called there.

Ÿ  He immediately rushed to him and found that pa ent was unconscious. His B.P. was not recordable, pulse not felt, no heart sound, respira on absent.

Ÿ  Hestartedcardiorespiratoryresusica onupto5.50a.m.buthiseffortswereinvain.Thushedeclared the pa ent dead at 5.50 a.m. Cause of death was sudden cardio respiratory arrest.

  

Ÿ  Modern Synopsis of Comprehensive Textbook of Psychiatry/III, II Edi on states that pa ent can die due to sudden cardio respiratory arrest while trea ng for schizophrenia. Thus he determined cause of death as Sudden Cardio Respiratory Arrest.

Ÿ  Itwascontendedthatcomplainantwasnotreadytoacceptthedeathofhersonshewasshou ngand weeping.

Ÿ  It was contended that her husband had given the respondent an idea about her hypertension while admi ng the pa ent in hospital. He therefore administered the injec on of Digrocam 10 mg to the complainant.

Ÿ  It was contended the anesthe st also tried respiratory resuscita on on the pa ent, but the pa ent could not be revived.

Ÿ  It was contended that the pa ent had schizophrenia. The pa ent’s father had given consent for administering ECT.

Ÿ  Therespondenthadprescribedhiman psycho cdrugsandtherewasnonegligenceonhispart. Findings and discussion

Ÿ  Thecomplainantdidnotpresentanysortofevidenceintheshapeofexperttoprovediagnosisarrived by respondent and treatment given by him was wrong and he had given high dose of medicine.

Ÿ  There was nothing to establish the connec on between cause of death and treatment given by respondent.

Ÿ  Theevidenceonrecorddidnotshowthatthedeathisa ributabletoanyactofrespondent.

Ÿ  No literature, documentary evidence or otherwise was brought before the commission by the
complainant, to prove negligence on the part of respondent.

Ÿ  Noexpert`sevidencewasledbycomplainant.

Ÿ  The burden to prove that the doctor was negligent lies on the complainant and it is not for doctor to show that he was not negligent.

Ÿ  No presump on for negligence can be drawn from the circumstances of incident.

Ÿ  It appears that doctor exercised proper skill and bestowed best of his a en on and care for treatment.

                                                                                                                                                                                                                                                                                                                                                                                            

Ÿ  Mereallega onsofthecomplainantwillnotsuffice.

Ÿ  Negligence cannot be presumed merely because complainant alleges, the same is required to be
proved.

Ÿ  Therewasnothingtoshowthatthetreatmentgivenbyrespondentswaspalpablywrong.

Ÿ  Complainant filed her own affidavit, affidavit of Dr. Y who had issued cer ficate in the inves ga on of the offence registered against present respondent.

Ÿ  According to Dr. Y who was working as Professor and Head of Department of Forensic Medicine and Toxicology, post mortem examina on should have been carried out since:
1. Pa ent was suffering from schizophrenia and schizophrenia is not the cause of sudden death,
2. Pa ent was not known for any cardiac or respiratory or any disease which may lead to sudden death,
3. The pa ent was apparently healthy,
4. If sudden death occurs in an apparently healthy individual it forms the basis of Medicolegal Autopsy. Witness stated in such case medical prac oner should not cer fy death without advising post mortem examina on.

Ÿ  Exact cause of death would have established by post mortem examina on. Doctor is only men oning the possibility of cause of death. Hence according to him doctor is negligent.

Ÿ  However, the affidavit of Dr. Y did not whisper about treatment given by respondent. He nowhere whispers that treatment given by doctor was wrong and medicines prescribed by him were excessive. He did not men on that high doses and ECT given by him resulted in the pa ent`s death. His evidence does not point out any sort of lacuna, and lack of management or negligence on the part of appellant.
Judgment

Ÿ  In response to the affidavit of Dr. Y, the state commission stated that respondent had determined the cause of death and thus there was no occasion to refer the
dead body for autopsy. It is unfortunate that the pa ent died
but for that respondent cannot be blamed since no
negligence has been established by complainant.

Ÿ  A er reviewing the reply of the opposite par es, the state commission summed up that the complainant had failed to prove any deficiency in service on the part of opposite par es in the ma er of his treatment.

  

 

Ÿ Accordingly,theappealfiledbythecomplainantwasdismissed.

Take away points

Ÿ  Pa entcandieduetosuddencardiorespiratoryarrestwhiletrea ngforschizophrenia.

Ÿ  Theburdentoprovethatdoctor’snegligenceliesonthecomplainant.

Ÿ  Negligence cannot be presumed merely because complainant alleges, the same is required to be proved.

Ÿ  If there is breach or failure in taking that reasonable care in treatment of the pa ent as is expected by normal standards of prac ce it cons tutes negligence.

Ÿ  Medical prac oner is not liable for negligence, simply because things went wrong from mischance/misadventure through error of judgment.

Ÿ  MedicalPrac onerwouldbeliableonlywherehisconductfellbelowthatofstandardsof reasonably competent prac oner in his field.

In Major Depressive disorder

INTELLIGENT ANTI DEPRESSANT

Ÿ Offer faster onset of action compared to other SSRIs1 Ÿ Significantly higher rate of response and remission

compared to other SSRIs & SNRIs1
Ÿ Better tolerated compared to TCAs, SSRIs & SNRIs2

also available

1, International Clinical Psychopharmacology 2014, Vol 29 (4) SSRIs : selective Serotonin Reuptake Inhibitors
2. Journal of Psychopharmocology, 2010 24 (8) 1143-1152 SNRIs: Serotonin and Norepinephrine Reuptake Inhibitors

TCAs : Tricyclic Antidepressants

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