Medicolegal case

Issue 3

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Case 2: Treatment for Bipolar Affecve Disorder (BAD) leads to the death of the paent due to Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)

Judgment:

Ÿ The State Consumer Dispute Redressal Commission stated that no expert in the field nor any authority was produced before the Forum to conclusively hold that in this case administraon of Lamotrigine OD simultaneously with Divalproex sodium was fatal.

Ÿ There is no evidence to prove that the treatment for SJS/TEN given to the paent was wrong. It was proved from the materials on record that upon admission of the paent in the nursing home she was finally diagnosed as a paent of TEN and was accordingly treated by keeping her in CCU.

Ÿ The complainant failed miserably to prove a case of medical negligence by the opposite pares for the treatment of the paent while she remained admied.

Therefore, the judgment made by the District Forum could not be sustained and was accordingly set aside.

Neuropsychiatrist challenges the decision of the District Forum for allegations of medical negligence resulting in neurotremor in a patient

Case of the complainant

Ÿ The complainant being a smoker, suddenly stopped that habit, on the advice of his family doctor, Dr. D which resulted in the development of mild giddiness, restlessness and sleeplessness.

Ÿ He therefore approached the 1st opposite party (OP1), a leading Neuro Psychiatrist for treatment on 25.8.2003 at about 11.00 a.m.

Ÿ According to the complainant, OP1 advised him to take out a brain mapping scan from the 2nd opposite party (OP2) and accordingly EEG brain mapping was taken, which was handed over to OP1.

Ÿ Complainant stated that on the basis of the EEG done, even without examining the complainant, OP1 prescribed certain tablets for 30 days and advised him to come for review on 24.9.2003.

Ÿ Based on the prescripon, the complainant purchased the medicines and consumed it as per the advice which caused sudden blurred vision, drowsiness and redness.

Ÿ Complainant averred that when these facts were reported to OP1, he informed him that the drugs consumed by the complainant would have that effect for 3 to 4 days, and thereaer everything will be alright. He therefore advised the complainant not to stop the medicine.

Ÿ At the same me OP1 informed the complainant that he would not be available between 31.8.2003 to 6.9.2003.

Ÿ The complainant having no opon connued the medicine while waing for the arrival of OP1.

Ÿ On 15.9.2003, complainant totally collapsed by the effect of the medicine, and therefore he was rushed to SR Hospital, where the problem was diagnosed as Neuro Tremor.

Ÿ The complainant said that he had showed the EEG brain mapping and on seeing the same the doctors have quesoned about the analycal report, which was not given by OP2, which they ought to have given.

Ÿ Complainant stated that because of the improper treatment given by OP1, in the absence of analycal report given for brain mapping, the complainant who was doing business was unable to connue the same.

Ÿ Complainantmournedthatthisresultedinhismonetaryloss.

Ÿ He therefore, approached the District Consumer Dispute Redressal Forum and

demanded compensaon from the opposite pares.

Ÿ The District Forum, considering the suffering experienced by the complainant directed the opposite pares, jointly and severally to pay Rs.15 lakhs along with cost of RS.15000/-.

Ÿ The opposite pares being aggrieved by the decision of the District Forum approached the State Commission for dismissal of the charges levied against them.

Case of the opponent

Ÿ OP1 admied that at his request brain mapping, i.e., EEG, was taken by the OP2 but he resisted the complaint against him contending that it is the normal pracce for him to get the EEG report without analysis report.

Ÿ He further stated that before preparing the analycal report, the complainant had taken the map, thereby OP2 was unable to give the analycal report.

Ÿ OP1 contended that aer due examinaon physically and clinically he had prescribed drugs Sertraline and Mirtazapine which are approved by the Drug Controller of India.

Ÿ OP1 contended that he had informed the complainant clearly that these drugs might produce mild drowsiness, redness, mild dizziness, etc., inially for about 3 to 4 days and then it will be reduced gradually.

Ÿ According to OP1, on 26.8.2003, the complainant informed him over phone about some problems and thus OP1 advised him to stop the drugs immediately.

Ÿ According to OP1, the treatment given by him to the complainant was perfect and he has not done any mistake and in fact he has taken absolute care to safeguard the complainant’s health and life being a renowned and qualified doctor.

Findings and Discussion

Ÿ There is absolutely no averment in the enre complaint regarding the alleged negligence said to have been commied by OP1.

Ÿ OP1 being a qualified person wanted to study EEG by himself, instead of impression or opinion given by the radiologist or the doctor concerned.

Ÿ Therefore according to OP1, EEG mapping alone was given and report was not obtained.

Ÿ Therefore, failure of OP2 to supply analysis report cannot be taken as wrong or deficiency in service. Furthermore, the said EEG was normal.

Ÿ However, it is true that a paent is entled to know, since paid, what is the result of EEG. In this case, that was not made available.

Ÿ The commission then sought the prescripon given by the OP1 to the complainant on 25.8.2003, wherein he prescribed the following medicines:

A. Lindep 50 mg (Sertraline given as an-depressant)

B. Mirt 30 mg (Mirtrazapine given as an-depressant and an-anxiety) C. Proto, 20 mg (Proponolol given as an-anxiety)

D. Lpam 2 mg (Lorazepam given as sedave at bed me)

Ÿ OP1 admied that for the disease the complainant was suffering the drugs required are Sertraline and Mirtrazapine, which are recognized/approved by the Drug Controller of India.

Ÿ It can be seen in the medical literature also that 25 mg 3 to 4 mes daily was recommended.

Ÿ It is also further stated in the medical literature that inially the drug is given as 50 mg OD, if the paent is not responding and then subsequently increasing at intervals of not less than one week, up to a maximum of 200 mg

daily.

Ÿ Therefore, the prescripon of this kind of medicine 50 mg twice and 30 mg once cannot be taken as excessive dosage or wrong prescripon.

Ÿ Moreover, since these medicines are meant for depression which also will have side effect, admiedly.

Ÿ Commission observed that the complainant though has not accepted the instrucons given by the OP1, regarding the taking of medicine.

Ÿ The leer pad of the OP further reads, “if you are not able to tolerate even these mild side effects or if you have same or other side effects in severe form, or if the side effects last for more than 5 or six days, please contact your psychiatrist immediately”.

Ÿ The complainant even as per the averments in the complaint, had not approached the doctor, despite problem and was taken to the hospital on 15.9.2003 where he was treated.

Points for determinaon

Ÿ WilltheorderpassedbytheDistrictForumalsobeheldbytheStateForum?

Ÿ Werethemedicineswronglyprescribedbythedoctorwhichresultedinneurotremorin

this paent?

Ÿ WastheradiologistnegligentinnotprovidingtheEEGanalysisreport?

Ÿ Wastheneuro-psychiatristnegligentinhandlingthepaentanddidprescribeoverdose of the said medicaons?

For the use of registered medical praconer or a hospital or a laboratory only.

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