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IV Antibiotic Without test dose: Apollo Hospitals, Surgeon told to pay Rs 10 lakh compensation

IV Antibiotic Without test dose: Apollo Hospitals, Surgeon told to pay Rs 10 lakh compensation

Bengaluru: The Bangalore Urban II Additional District Consumer Disputes Redressal Forum has directed Apollo Hospitals and a pediatric surgeon to pay a compensation of Rs 10 lakh to the couple for causing the death of their only son on account of administering an antibiotic injection without giving the child a test dose.

The case pertains to a patient, age 1 year 4 months, who was brought to Apollo Hospital, Bannerghatta Road and was diagnosed with Bilateral Scrotal swelling with right inguinal Hernia. Dr. Anand Alladi, Paediatric Surgeon at the hospital suggested surgery for the same, which was performed and the patient was shifted to the ward. It was alleged by the family that after the surgery, the surgeon did not take post-operative care and had telephonically informed duty nurse to give Augmentin – 300 mg injection intravenously. On the telephonic instructions, a duty nurse without giving test dose administered antibiotic, within few minutes of drug infusion the child developed an allergic reaction and the child’s condition started deteriorating. It was further alleged that the doctor could not be contacted and was soon pronounced dead

The family filed a complaint with the  Karnataka Medical Council, which conducted an inquiry and has given report augmentin injection was administered without a test dose to the child and held the surgeon responsible for medical negligence.

The family then filed a complaint for compensation with the forum demanding Rs 20 lakhs.

In their response, Apollo Hospital stated that there is no specific allegation made against the hospital.Further, the hospital stated that child was normal after the surgery but developed a problem after infusion of augmentin but contended that the infusion was given after test dose. it stated that after the child allergic to the medicine, Doctors attended the child to monitor from morning to evening but despite all efforts by a team of doctors the child succumbed to adverse drug reaction The hospital denied all other allegations of the complainants

The Doctor in his defense stated that he has instructed a duty nurse in the hospital to administer augmentin injection intravenously but he stated that he instructed to give test dose. It is not in dispute that augmentin injection has a combination of penicillin and when such high dose given to a child of 1 year 4 months test dose ought to have been given and it is necessary.

The doctor further added that the actual fact is that as on instructions the Duty Nurse reconstituted a drip of injection Augmentin at 11.15 am, gave a test does and after properly observing and ensuring that there were no adverse reactions, completed the full dose as a drip, by 11.45 am. Long after this, at 11.55 am, well after the drip was completed, the child started showing abnormal behavior and was restless. Immediately, as it was an emergency, resuscitation started by the available doctors.

The court observed that the main contention to be whether the test dose of the antibiotic was given or not.

The court noted that while the doctor had stated that he had directed the nurse to give a test dose, his statement here is contrary to his admission made in other proceedings that there is no proof for he having instructed for test dose. Complainants had pointed out that after the death of the child they lodged a complaint before the Karnataka Medical Council who held an inquiry and found the doctor guilty of Medical Negligent.

Further with the Cross Examination, it is clear that he did not spend some time with the child after surgery until the reaction of the medicine like augmentin was given. He also admitted that he was not present with the patient to take care, he prescribed administering augmentin injection over phone to a duty nurse. The sentence he has used is, he “prescribed injection Augmentin-straight advised I.V.” but he never stated that he had told the duty nurse to give test dose, the word “Straight” gives the meaning administer indicates not informed test dose.

The court noted the findings of the Karnataka Medical Council of that inquiry has given
a finding and held that there were no senior doctors to attend the emergency of the child of the complainants, the telephonic communication could not be established that doctor arrived to the hospital it was too late and held there is deficiency in service and violation of code of medical ethics and held that the death of child was due to “anaphylaxis” i.e. drug allergy. The hospital has also been warned in this regard by Karnataka Medical Council

With the above observations, the forum said that the doctor was held guilty for his professional negligence which is to be accountable by the hospital also. The court awarded a compensation of Rs.10,00,000/. Attached is the judgment of the case

Source: self
38 comment(s) on IV Antibiotic Without test dose: Apollo Hospitals, Surgeon told to pay Rs 10 lakh compensation

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  1. user
    Dr malapure s m March 20, 2018, 7:33 am

    Most of us give test dose for procaine penicillin and xylocaine test dose. To the best of my knowledge no other drug given test dose. It is said any thing under the sun including son( pregnancy) can be allergic. The first and best drug in anaphylactic shock is adrenaline.

  2. user
    Dr Funmilayo James FMCS February 21, 2018, 11:18 pm

    I think a dose of 300mg of augmentin for a child of 1 year 4 months is on the high side especially for prophylaxis in a supposedly clean surgery. Some adverse drug reactions are dose dependent. It has not been customary to give test dose for intra venous amoxycillin unlike 1st generation penicillin like benzyl penicillin or crystalline penicillin .The reaction might be due to overdose. Allergic reaction is not necessarily dose dependent and that is where a test dose is important .

  3. Test dose is not required for Augmentin. at least in adults.

  4. Sorry to note that the antibiotics if required should have been written in the post op instructions rather telephonically.So is to be clarified and that normally in the instructions ,it would haven specified.

  5. Many people including doctors are not aware that allergy in any form is not dose dependent. So, the test dose given is not the foolproof method of assessing allergy. Radio spectro photometry is the only reliable method for assessment of medicine allergies which in turn isn’t available under ordinary circumstances. Then comes the million dollar question why on earth we are administering the test dose. For the sake of litigation & other hassles. In this case, the problem is the surgeon should have written in operative notes about medicines tobe given & whether test dose is to be given. Over phone prescribing of antibiotics & other risky drugs are to be discouraged. The sub ordinate staff can always deny the advice of test dose. Usually nurses have that sense to correct the doctor when errors occur. Here that didn’t happen. I can only say Bad Luck.