Sankar Kumar Mitra & Anr vs Dr. Indira Jha & 10 Ors

This is a case of alleged medical negligence causing death of Smt. Shanti Mitra (since deceased - patient). The complainant no. 1, Shankar Kumar Mitra is the husband of the deceased, whereas Manas Mitra, the complainant no. 2 is the son of the deceased.

Briefly stated facts are that the patient was a known case of seizure disorder which was diagnosed on 15.09.2000 at CMC, Vellore and she was under treatment and advised to take medicines (tablet) of Tegretol 200 mg thrice a day and tablet Osteocalcium once a day. As the patient was resident of Howrah District, she took further treatment from Dr. Sital Ghosh from 22.11.2001 to June 2006. It is stated that on 21.06.2006, the patient was admitted in B.R. Singh Railway Hospital, Sealdah, Kolkata and took the treatment from Dr. Indira Jha (opposite party no. 1). The patient was discharged on 09.08.2006. She was diagnosed for "seizure disorder, chronic hypertension, chronic liver disease and hepatic encephalopathy". The patient was advised to attend the OPD of Gastrology and Neurology, thereafter. It was alleged that the opposite party no. 1 never followed the advice of Dr. T. P. Joseph given at CMC Vellore and Dr. Sital Ghosh, who treated her previously, despite the patient had handed over the previous treatment record (2000-2006) to the opposite party no. 1 at the time of admission. According to the complainant, the patient was admitted in B. R. Singh Railway Hospital repeatedly from 11.09.2006 to 13.10.2007. The patient was diagnosed as CLD hepatic encephalopathy and seizure disorder and portal hypertension. On 30.10.2007, the patient was once again admitted in the Railway Hospital for her severe back-pain. She was referred to Howrah Orthopaedic Hospital on 24.11.2007. Dr. Subrata Basu (opposite party no. 2) opined that the patient was suffering from seizure disorder, dorsal spine, fracture with marrow oedema of D11 and D12 vertebra, tuberculosis and carries spine. He has suggested for the MRI of the dorsal spine and then the patient was referred to Railway Hospital for further treatment. The MRI was performed on 29.11.2007, which detected as fracture with marrow oedema in D11 and D12 vertebra. The spinal cord and canal were normal. According to the opposite party no. 2 the patient was suffering from tuberculosis and caries spine, thus he started anti tuberculosis drugs. Thereafter, the patient's condition was deteriorating, therefore, the patient was transferred for further treatment of tuberculosis at RNTCP (Revised National Tuberculosis Control Programme), Howrah. There, her treatment was started from 29.11.2007. The patient was admitted in the Railway Hospital on 06.12.2007 and was discharged on 12.12.2007. There, she was again diagnosed for caries spine, CLD and portal hypertension and she was put on INH and PNZ and the other drugs were stopped. The patient again got admitted in B. R. Singh Railway Hospital on 22.01.2008 and was discharged on 25.01.2008. Thereafter, the patient again got admitted in the Railway Hospital on 08.03.2008 under the treatment of Dr. Sharmistha Mukherjee (opposite party no. 4) and was referred to chest clinic, where opposite party no. 5 (Dr. Angira Dasgupta) opined that the patient was suffering from miliary tuberculosis and CLD. The patient was advised to attend Health Centre Orthopaedic Hospital, Eastern Railway, Howrah. The said doctor stopped the neurological medicines without consulting any neurologist.

The patient was again admitted at B. R. Singh Hospital, Sealdah on 20.09.2008 and she (patient) died on 19.10.2008. The patient was under the treatment of the opposite parties no. 4 and no. 1 (Dr. Sarmistha Mukherjee and Dr. Indira Jha). The cause of death was recorded in the death certificate as "Decompensated chronic Liver Disease with Hepatic Encephalopathy, Seizure Disorder, Sick Sinus Syndrome with permanent pacemaker implant with Old Fracture Spine". But during her life time, the patient was never treated for the said old fracture, rather the patient was sometimes treated for caries spine and sometimes treated for miliary tuberculosis at the whims of the opposite parties no.1 to 5 who preferred to juggle with the life of the said patient instead of making a perfect diagnosis of the disease of the patient and treating her accordingly.

Being aggrieved, the complainants filed a complaint before the State Consumer Disputes Redressal Commission, West Bengal, Kolkata seeking the total claim amount of Rs. 65,00,000/- towards compensation and damages due to deficiency in service on the part of the opposite parties.

The opposite parties filed their written versions and resisted the complaint stating that the patient had been suffering from multiple ailments which have been mentioned in the treatment sheet and in the report of the medical board. It is submitted that no expert evidence was adduced by the complainants and in absence of such evidence, it cannot be said that there was negligence on the part of the opposite parties (doctors). It is submitted that the medical board was constituted and the matter was explained to the complainants as to the ailments diagnosed and the treatment done. It is submitted that the complainants signed in the report of the medical board. It is submitted that proper investigation was made and the treatment was done as per the standard medical practice and procedure. It is contended that there was no medical negligence on the part of the opposite parties.

The opposite party no. 6 has adopted the same defence which was taken by the other opposite parties in their written versions. In addition, it is submitted that in the complaint there was no specific allegation as against the opposite party no. 6. It is submitted that the opposite party no. 6 was only a member of the medical board and no treatment was done by him.

According to the opposite parties, the patient obtained treatment free of cost in Railway Hospital, thus, the complaint was not maintainable. The patient was suffering from multiple ailments like seizure disorder, chronic liver disease with portal hypertension with oesophageal varices, sinus node dysfunction, osteoporosis and tuberculosis of spine. For the above ailments, she was admitted several times (13 times) and each time she was discharged in stable condition with proper advice for treatment and follow up to which she never complied with. Every time the complainants no. 1 and 2 were explained about the conditions and prognosis of the patient. There was no negligence on the part of the treating doctors as the patient was promptly attended and relieved of her symptoms before she was discharged. Whenever her condition deteriorated she was treated in I. T. U. and also in I.C.C.U. During all her admissions 10 doctors have examined, advised and treated her with proper investigations which indicate that there was no negligence at any point of time. The patient needed repeated admission because of chronic and progressive nature of her diseases and not due to any negligence on the part of the treating doctors. The opposite parties also submitted that the medical board reviewed the condition of the patient and opined that the total cure and recovery was uncertain because of her multiple ailments and there was no negligence while treating the patient.

The State Commission after hearing the parties dismissed the complaint as the complainants have totally failed to prove the medical negligence or deficiency in service on the part of the opposite parties. Hence, the complainants, being not satisfied with the findings of the State Commission, filed the instant first appeal.

Heard the learned counsel for both the sides. Perused the material on record.

We note that the allegations of the complainants are in two fold. Firstly, it is the case of the complainants that the patient had been suffering from epilepsy and she was treated accordingly both at CMC, Vellore and also by Dr. Sital Ghosh. It was the contention of the complainants that the medicines prescribed at CMC, Vellore and by Dr. Ghosh for epilepsy were discontinued by the doctors at B. R. Singh Hospital. It was contended that no treatment was given for the neurological problems. On this point it is found from Annexure-A to the complaint at Page-20, that is, the medical report issued by the Department of Neurological Sciences, CMC, Vellore dated 15.09.2000 that it was diagnosed to be a case of temporal lobe epilepsy. Recommendations were:

"Tab. Tagretol 200 mg. thrice daily

Tab. Osteocalcium 1 once daily."

Secondly, it was the specific contention of the complainants that the patient had never been suffering from tuberculosis and without proper investigations, anti-tuberculosis drugs were administered, for which her condition started deteriorating. On this point we find from the medical records of the patient that the MRI of dorsal spine was done on 03.07.08 and the impression was that there was partial collapse with marrow edema of D12 body. As per impression on MRI dated 25.06.2008 there were:

1) D12 body partial collapse with marrow edema of D12 body

2) Lumber spondylosis with degenerative disc disease

3) L 4-5 and L5-S1 building disc with facet arthropathy causing central canal and neuroforaminal stenosis

4) L 1-2 and L 3-4 bulging disc.

MRI of dorsal spine dated 29.11.2007 shows the impression as "Fracture with marrow edema is seen in bodies of D11 and D12 Vertebrae."

According to the guidelines of tuberculosis of World Health Organization (WHO), the treatment in case of pulmonary tuberculosis and caries spine is the same. In my opinion, the patient was a known case of seizure disorder and elderly. She was under treatment of temporal lobe epilepsy and taking medicines Tegretol 200 mg and Osteocalcium 1. The medical record of the patient clearly reveals that in the Railway Hospital, the treatment was continued and the patient was treated for the other ailments, whenever she was got admitted in the hospital. The MRI report reveals the evidence of carries spice of D11 and D12 and it was diagnosed as tuberculosis spine D11 and D12. As per the RNTCP guidelines, the patient was started with anti "Koch's treatment, therefore, in my view, it was the correct and standard of practice for the treatment of such patient. Thus, complainants' allegation that the patient was not suffering from tuberculosis is not sustainable in this case. The treating doctors have taken all the necessary steps and relying on the investigation reports patient was given proper line of treatment. I do not find any deficiency or negligence in the treatment of the patient. However, the death of the patient was not due to anti tuberculosis drugs rather it was due to multiple ailments which she was suffering from.

On the basis of foregoing discussion, I do not find any merit in the instant appeal, hence dismissed.