Medicolegal case

Issue 8

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First 3 early bird entries will get exciting prizes

Case 7: A case of medical negligence on the treang psychiatrist and hospital alleged because of the suicide commied by a psychiatric paent

Judgment:

Ÿ The State Consumer Disputes Redressal Commission stated that just an error in judgment cannot account for medical negligence against the opposite pares.

Ÿ Complainants failed to establish that it was on account of the carelessness and negligence on the part of opposite pares that the paent happened to kill himself.

“Resultantly, the complaint was dismissed by the State Commission.”

Psychiatrist alleged of negligently administering Haloperidol in an alcoholic patient resulting in his death

Case of the complainant

Ÿ Complainantno.1Smt.R’shusbandMr.HwasaCaptaininNavy.

Ÿ He was earlier habituated of consuming alcohol but had given up the said habit since

the last 25 years.

Ÿ However, when he was sailing near Andaman and Nicobar Islands, there was Tsunami which had le behind deaths of hundreds, seeing which he was psychologically and mentally disturbed and signed off the ship in February 2005 and due to trauma, he again started consuming alcohol.

Ÿ He was immediately affected and was admied in J Hospital from where he was discharged aer two days.

Ÿ However, he started drinking again. To treat him for proper detoxificaon, the complainant approached the opponent’s hospital where she was informed that opponent doctor was competent to treat the said problem.

Ÿ Thepaentwasadmiedinthesaidhospitalontheeveningof13thDecember2005.

Ÿ At the me of admission the paent was fully conscious and he told the in-house Dr. S that he was feeling congeson in his chest and also suffering from asthma, blood pressure and was diabec.

Ÿ Thepaentthereforehadrequestedtoadministeronlysalinetohimandnomedicaon as he had consumed alcohol and also had a cough.

Ÿ However according to the complainant, another in-house Dr. A injected a sedave “Serenace 10 mg” and did nothing to remove the cough. Thereaer, paent started breathing very heavily with hissing sounds.

Ÿ The opponent doctor came in later and tried to talk with the paent but the paent did not respond on account of sedaon. Hence opponent doctor injected “Phenergan”.

Ÿ Aer 45 minutes the paent suffered a cardiac arrest due to which he was shied to I.M.C.U. and put on venlator where he remained unconscious for two and half days.

Ÿ Aerhegainedconsciousness,hestarted hallucinanganddidnotsleepfortwodays.

Ÿ The complainant thus contended that although the opponent pares were aware that when a paent is under the influence of alcohol, it was not at all safe to inject the paent with sedave “serenace 10 mg”, the same was injected causing cardiac arrest and further complicaons.

Ÿ It is also the case of the complainant that the paent who was being given ‘A’ class facility was shied to general ward in I.M.C.U. on 18th December 2005.

Ÿ On 19/12/2005 at 6 a.m. the paent suffered second cardiac arrest and he went into coma and remained in the same state ll his death i.e. on 15/09/2007.

Ÿ The opponent pares to avoid legal acon against them, the complainant was asked to sign some papers and then only the dead body of the paent was handed over.

Ÿ Thus, on the basis of the aforesaid grounds, the complainants filed a complaint alleging deficiency in service against both the opponents seeking direcons to them to cancel the costs of hospitalizaon and final bill of Rs. 16 lakhs, to pay compensaon of Rs. 63 lakhs towards loss caused to the complainants and mental agony along with Rs.1 lakh as costs of complaint.

Case of the opposite pares

Ÿ Both the opponents appeared before the Commission and resisted the claim of the complainants by their separate wrien versions.

Ÿ At the outset, it is submied that the complaint is barred by limitaon as per secon 24- A of Consumer Protecon Act, 1986 as the same is filed on 02/09/2009 i.e. much aer lapse of two years from the date of cause of acon which is 13/12/2005 as per the complaint, without filing separate applicaon for condonaon of delay.

Ÿ The opponent doctor specifically submied that on 13/12/2005 as submied by the complainant the in-house doctor A administered injecon “serenace 10 mg” under the instrucons of opponent doctor.

Ÿ It is specifically denied by the opponent pares that due to administering of “inj. serenace” and “inj. Phenergan” there was cardiac arrest to the paent.

Ÿ It is submied by opponent doctor that aer examining the paent at 8.30 p.m. on 13/12/2005 and knowing from the paent’s wife that the paent was coughing and suffering from high BP with diabetes mellitus, aer consulng senior doctor S from opponent hospital, they recommended the injecon of serenace with injecon Phenergan to control the aggressive and violent behavior of the paent.

Ÿ OPs further submied the paent was treated earlier in J Hospital on 03/07/2005 with the same drug i.e. serenace even then he was found alcoholic and there was no such case of any cardiac arrest to him.

Ÿ Hence, confirming that the said injecon of serenace was safe and effecve to control ‘dystonia’ of the paent.

Ÿ On 16/12/2005, the paent again exhibited violent disrupve behavior and thus tablets of serenace and pacitane were administered.

Ÿ It was observed that the paent had symptoms of syndrome of alcohol withdrawal for which serenace and phenergan were to be administered.

Ÿ On 17th December, he was administered only oral anpsychoc and calming medicine. When on 18th December, the paent had cardiac arrest, the injecon of senenace and phenargan were not administered.

Ÿ Aer the cardiac arrest, he was promptly resuscitated i.e. brought to consciousness. However, his neurological status did not improve

unl his demise.

Ÿ It is further submied by the opponents that the medical literature filed by the complainants is not a literature but only leaflet and computer print outs of informaon available on internet.

Ÿ They are used as a reference only for a person indulging in self-medicaon and not for a doctor.

Ÿ Thus the opponents have denied to the allegaons of the complainants that the paent had cardiac arrest due to injecon serenace and that of injecon phenergan.

Ÿ It is also submied that the paent’s status of treatment from ‘A’ class was lowered to general class only on the request of the complainant so as to avoid extra financial burden without any change in the treatment.

Ÿ Thecomplaintno.1hadalsogiveninwringbeforethepolicethatshehadnocomplaint against both the opponents.

Ÿ The opponents thus submied that the present complaint is false and have no support to the allegaons made against be dismissed with costs.

Arguments by the counsel for the complainant

Ÿ The learned counsel for the complainant, Mr. PT, submied a literature which prohibits the administering of the said drug when a person is under the influence of alcohol.

Ÿ However, it was pointed out by learned counsel for the opponent doctor, Mr. PR that the documents as filed by the complainant includes only leaflet and the informaon as obtained from the internet and the same cannot be termed as ‘medical literature’.

Arguments by the counsel for OPs

Ÿ Themedicalliteraturewasfiledbythelearnedcounselfortheopponents,Mr.PR,which consisted of extracts of various medical books and hence weight over the leaflets and informaon obtained from the internet.

Ÿ Mr.PR referredtotheextractof”TextBookofPsychosomacMedicineeditedbyJames L. Levenson, M.D. which provides treatment for “Alcohol induced psychoc disorder” as under:-

© “When paents experienced alcoholic hallucinosis during detoxificaon, a potent anpsychoc such as haloperidol 2-5 mg orally twice a day, is typically needed to control agitaon and hallucinaons.”

Ÿ It is further provided “when people suffer from hallucinaons and delusions (psychosis) they can become agitated, scare or aggressive and will not respond very rapidly to other peoples’ reassurance or help. In this situaon, medicaon of haloperidol (serenace) is used to help agitated people relax and become more tranquil or to sleep.”

Findings and Discussion

Ÿ Ld. counsel for opponent doctor contended that the complaint is hopelessly barred by limitaon as prescribed under provisions of the secon 24-A of Consumer Protecon Act, 1986.

Ÿ Thus,accordingtolearnedcounselMr.PR,thedateofcauseofaconis13/12/2005and considering the date of filing of consumer complaint as on 02/09/2002 he contended that the complaint is barred by limitaon.

Ÿ The only ground of allegaon of medical negligence as put forth by the complainant is that the injecon of Serenace though not advisable to be administered when the paent is under influence of alcohol, the opponents have administered the same on 13/12/2005 which caused cardiac arrest to the paent.

Ÿ The queson is therefore whether the paent was under influence of alcohol and whether Serenace injecon is responsible for the cardiac arrest leading to further death of the paent.

Ÿ On the perusal of the complaint, it reveals that on or about 10/12/2005 the paent started drinking again and therefore, for proper detoxificaon he was admied with the opponent hospital on evening of 13/12/2005.

Ÿ There is no menon that the paent had consumed alcohol before admission and that he was under influence of alcohol, etc.

Ÿ Thus, we find that when there is an acute agitaon of the paent the haloperidol or serenace is recommended to be used by the doctors.

Ÿ It is further to be noted that the opponent doctor has produced the affidavit of Dr. Y, as expert evidence.

Ÿ He is qualified as M.D. Psychological Medicine from Mumbai University in 1988 with other qualificaons.

Ÿ As per his affidavit, there is a clear opinion that the combinaon of the drug serenace and phenergan as intramuscular and intra venous injecons can be safely given in doses as high as 40 mg in paents of alcohol and presenng with pshycoc symptoms and disrupve behavior.

Points for determinaon

Ÿ Were the treang doctors negligent in administrang injecon serenace while the paent was sll under the influence of alcohol?

Ÿ Can an informaon obtained from the internet websites be regarded as admissible evidence in the court?

Ÿ Was the complaint barred by limitaon, i.e. it should have been filed within a years of the event?

Ÿ Weretheoppositeparesnegligentinmanaginganalcoholicpaent?

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

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