ARUNA TRIKHA vs SEHRA MEDICAL CENTRE

THIS is a complaint filed by Mrs. Aruna Trikha against M/s. Sehra Medical Centre, respondent-1 and Dr. Devender Sehra, respondent-2 claiming total compensation of Rs. 46,29,006/- from respondents for gross negligence in the treatment of ailment suffered by the complainant between 21st November, 1989 to 30th November, 1989, while the complainant was admitted as an indoor patient at the respondent No. 1-centre. The complainant has alleged that due to delay in the appropriate treatment, the complainant is permanently afflicted by sickness and inability to perform office duties. In the result, the complainant has been retrenched from her service with Phillips India Ltd. She was drawing the handsome salary of Rs. 5,521/- per month and was aged only 42 years. Due to premature retirement, she has suffered on all fronts vis-a-vis in salary promotions in the service, other perks etc., for the remaining period of her service and hence the above compensation is claimed.

FACTS of the case are, in the evening of 21st November, 1989 the complainant all of a sudden developed acute pain in her temples, associated with fever, vomiting and nausea. Her husband took her to respondent No. 1 Hospital (Centre) at 11 p.m. on that day and respondent No. 2 attended on her. On tests being carried, complainant was identified for urine infection. She was administered ''Ciplox'' capsules and this treatment terminated urine infection but the temperature persisted. Respondent No. 1 on trial and error basis treated the complainant for Malaria with ''Lariago''. However, the fever persisted on 23rd November, 1989. Since the headache and the temperature did not abate, the husband of the complainant requested complainant No. 2 to consult Neuro-Surgeon Dr. Rana. It is further contended that respondent No. 2 treated complainant for Malaria for first four days and then switched on to the treatment of Typhoid, as symptoms appeared to be of Typhoid. Tab Chloromycitin was prescribed but the response was poor and the complainant deteriorated in health. On further request for advice of Neuro-Surgeon, respondent No. 2 stated that he was a qualified Neuro-Physician and that the husband should not worry about the complainant. However, respondent No. 2 asked the husband whether he felt that the complainant was suffering from ''Meningitis'' to which her husband stated that he heard of it but could not describe the symptoms. He again asked for consultation with Neuro-Surgeon and further ''Cat Scan''. But, respondent No. 2 said that his was the case of ''Typhoid'' and refused to refer the patient for C.T. Scan. Complainant was given Chloromycitin tabs for 4 days and then was administered intravenously ''Chloromycitin'' by respondent No. 2 as it was confirmed to be ''Typhoid''.

IT is complainant''s case that on 30th November, 1989, the complainant developed double vision and the complainant''s husband asked for relief from respondent No. 1 Centre and only then, respondent No. 2 advised removal to Gangaram Hospital instead of AIIMS (All India Institute of Medical Sciences). However, complainant was admitted to AIIMS on 30th November, 1989 at 1 p.m. While in AIIMS, complainant developed ''Paralysis'' of left side followed by ''Hamicoria - violent Movements'' of right Arm and leg. She also suffered jaundice and was in AIIMS from 30th November, 1989 to 23rd March, 1990. Complainant lost weight, suffered loss of memory, and the doctors at AIIMS lost hope about the survival of the complainant.

IN their written statement respondents alleged that the complaint was false, and that the complainant had suffered attack of meningitis in September, 1989 - affecting her brain and nervous system, but did not disclose this fact to the respondents and avoided going to the bigger hospital. Complainant took VRS from service and got the amount of Rs. 1,70,145/- for voluntary separation and Rs. 60,000/- as gratuity. It is further alleged that she wrongly informed the Income Tax Authorities about retrenchment and got refund of tax deducted under Section 10(10-B) of Income Tax Act and suppressed this material fact from the Commission. The husband of the complainant paid the bill of the respondent in January, 1990 but did not make complaint about negligence. He paid only Rs. 2,000/- against the bill of Rs. 3,400/-. Respondent No. 2 did not charge any professional fees. Respondents contend that complainant came to respondent No. 1 Centre on 22nd November, 1989 at 11 p.m. and was under treatment till 30th November, 1989 (8 nights). She had primarily the complaint of fever, occasionally accompanied by vomiting and sometimes by headache. On the basis of reports brought by the complainant it was felt that she had either urine infection (pus cells - 8 to 10 per high power field) or Typhoid. She was given Ciplox Tabs (Ciprofloxacin) useful for urine infection and Typhoid (Broad Spectrum Antibiotic). Then as the temperature did not subside, Chloromycin (orally and intravenously) was given, the same being equally effective for Typhoid and urine infection. She was then treated for Malaria by ''Lariago''. General and neurological examination did not show any weakness or loss of senses of any part of the body. There were not definite signs of ''meningitis''. This treatment was continued up to 30th November, 1989. Further examination initially showed Nasal Blurring - later suggested doubtful left side pappilodema on 30th November, 1989.

IT was only on 27th November, 1989 blood vidal test came to be negative meaning that Typhoid had to be ruled out Urine infection had disappeared with administration of Ciplox and despite all this, was not subsiding and hence respondent No. 2 concluded that fever could be something different from typhoid and, therefore, referred the patient to the bigger establishment for better management. On 28th November, 1989, Mr. Trikha - the husband told respondent No. 2 that bed would be available within two days. However during all this period, the patient was conscious, well-oriented and co-operative and her only complaints were fever and occasional vomiting. On 29th November, 1989, patient was advised removal to a bigger establishment viz. Gangaram Hospital. However, finally patient was shifted to AIIMS on 30th November, 1989 at 1 p.m. Meanwhile, respondent No. 2 got liver function test i.e., Serum Bilirubin - for better management. At the time of discharge, the patient was fully conscious, well-oriented with time, place and person. It is further contended that there were no signs of meningitis, neurological deficit, either in the form of any motion system or nervous system involvement. Between 29th/30th November her examination was showing left sided pappilodema as nasal blurring was associated with temporal blurring.

IN the referred slip to AIIMS, it was indicated that as fever was not subsiding with broad spectrum, antibiotics and lariago, she was referred to a bigger establishment for further management as a suspected case of drug fever/TBM (Tubercular Meningitis). Since treatment is based on symptomatic ailments, the respondent averred that every possible symptom was immediately treated but at no time symptoms of meningitis were seen. The respondent stated that it was suspected that there could be drug fever, pirax of unidentified origin due to kotch Etiology. There was no negligence whatsoever on the part of the respondents. Hence respondents pray for dismissal of the petition with costs. From the arguments raised, we note the points to decide are : (1) Whether the complainant proves negligence on the part of the respondents in the treatment for her ailments ? (2) Whether the respondents followed the standard treatments in regard to the ailments of the complainant ? (3) Whether the complainant is entitled to compensation ?

We have evidence before us which comprises of oral evidence of complainant Aruna Trikha and her husband S. P. Trikha and respondent No. 2 Dr. Devender Sehra, and affidavits of Dr. Rajesh Garg and Dr. Vinod Puri on behalf of the respondents and affidavit of Shri I. B. Singh on behalf of the complainant.

AT the outset, we may observe that the complainant has filed the list of two witnesses viz. doctors to bolster her case of medical negligence but later on gave up the witnesses that they have been pressurized by respondents not to depose against medical fraternity. They are Dr. Sen of Phillips Company and Dr. S. Kumar, and the visit of Dr. Sen to respondent No. 1 Centre to see the complainant has been admitted by the husband of the complainant. The long and short of it is that no medical opinion is available to support the case of the complainant. Mr. Trikha on the other hand has clearly admitted that every case of headache need not necessarily be a case of neurological problem - landing on meningitis or tubercular meningitis. With such poor perception about the ailments, it would be unfair to rush to the conclusion the respondent No. 2 avoided the treatment for neurological ailment and that early treatment in that direction would have avoided further agony of the complainant. Smt. Trikha in her cross-examination admitted that at AIIMS, doctors told her that there was negligence on the part of respondent No. 2 in her treatment. But she could not name the doctor who told her about it. It is only her husband that told her about the negligence in the treatment by respondent No. 2. Mr. Trikha only insists that since Mrs. Trikha had temperature coupled with headache for couple of days, neurological examination was completely warranted. However, he also admits that every headache is not a neurological problem. In absence of medical opinion supporting the version of the complainant, we do not find that there was negligence. Documents and omissions on the part of the complainant amply establish that the complainant was admitted to centre on 22nd November, 1989 at 11 p.m. and the effective treatment was started on 23rd November, 1989.

HOWEVER we find in the cross-examination of Mr. Trikha that he has admitted that it took 3 days for the transfer of complainant from general medicine ward to neurological ward at AIIMS. When a patient takes 3 days for transfer from one ward to another, Dr. Sehra rightly says that it took 3 days for Mr. Trikha to get admission for Mrs. Trikha to AIIMS. We find that entries in AIIMS papers show identical treatment for first five days. Doctors treated Mrs. Trikha for Typhoid, PUO and carried out CT Scan and then Lumber Puncture. Ultimately tubercular meningitis was detected and treatment was modified to secure the arrest of the disease. The final recovery appeared at the end of March, 1990.

WE also feel that Dr. Rajesh Garg and Dr. Vinod Puri who are M.D. and D.M. in Neurology and connected with AIIMS and G.B. Pant Hospital respectively have upheld the treatment given by Dr. Sehra to the complainant in their affidavits. The medical literature from Patton''s Textbook of Neurology, Oxford textbook of medicines amply suggest that lumber puncture would be life threatening in case of raised intra-cranial tension which can be ascertained by CT Scan.

AS it is, the complainant is not entitled to any relief. On the other hand, she does not come with clean hands on the issue of voluntary separation from service. She claims that she was retrenched and she has got refund of Income Tax amount on lump sum payment received while leaving the service. Because of retrenchment, she has got benefit of tax-refund. In fact, this is undoubtedly a case of voluntary separation of service with Peico Ltd. We find that the treatment given by respondent No. 2 has its echo in the initial treatment at AIIMS and that can be seen from case papers of AIIMS. Doctors at AIIMS were also on the same path of treatment when fever was not subsiding. By process, of elimination of possibilities of urine infection, typhoid, pirax of unknown origin, jaundice, they finally landed on anti-tubercular meningitis treatment (ATT).

WE may state that when different ailments mimic same symptoms, doctors follow the procedure of elimination of one after another ailments and prescribe medicines accordingly. The aggressive procedure to cure one ailment may prove disastrous in case other ailment is the final diagnosis. Hence elimination by administering all pervasive medicines may be beneficial for the welfare of the patient. There are no deviations from the main course of treatment. We firmly believe that Dr. Sehra followed the standard treatment. He predicted tubercular meningitis, as seen from referral note, and the same is the fact as per case papers of AIIMS.

HOWEVER , since we do not find negligence on the part of the respondents, we are not discussing the question of compensation complainant prayed for in the complaint. With the above discussions, we pass the following order : ORDER The complaint is dismissed. Parties are left to bear their own costs.