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Hospital, Doctor to Pay 13.6 lakh for Using Outdated Malaria Treatment

Hospital, Doctor to Pay 13.6 lakh for Using Outdated Malaria Treatment

Rajkot: A medical practitioner and associated hospital were recently directed by the Gujarat State Consumer Disputes Redressal Commission (GSCDRC) to pay a compensation of Rs 13.6 lakh to a patient’s family after the forum held them guilty of medical negligence in providing treatment to a Malaria patient leading to her death in 2013.

The case is that of a patient, who came under the care of Dr Mayank Thakker at Giriraj Multispecialty hospital with complaint of fever for past 5-6 days. Following a blood test, she was diagnosed with P Falciparum Malaria.

The patient was immediately admitted to the hospital on the advice of the Dr Thakker. Considering her critical condition, the doctor opted for Exchange Blood transfusion (EBT) as a mode of treatment.

The patient’s family had alleged no doctor was available to attend the patient. It was also alleged that after the constant deterioration in her health, “one unqualified lady (Aaya)” gave an injection and started drips without consulting the doctor. As the patient’s condition deteriorated and her BP went 70 mmHg she was shifted to ICU

The family of the deceased further alleged that they approached another doctor in Surat who advised that the patient be shifted to another hospital, but it was ignored by the treating doctor, who again started the outdated EBT Procedure. A nephrologist was also consulted, who started the patient on Quinine Treatment. However, the patient’s condition kept on worsening and she died soon after.

Refuting all allegations, the hospital and the doctor contended that doctor provided treatment to Madhuben as per World Health Organisation (WHO) guidelines and all the allegations made in the complaint regarding outdated treatment are totally false.

“According to the opponent doctor, in addition to WHO guidelines in the treatment of malaria, another renowned standard medical textbook ’18th Edition Hen-son’s Principles of Internal Medicine’ (Vol. 1) on page 13 of 16 it has been mentioned that exchange transfusion may be considered for severally ill patient…. The opponent has also referred to Medical textbooks and relying upon said materials asserted that Madhuben was having laboratory test reports suggestive of critical condition,” the court noted.

After going through the submissions the court noted

In so far as the written statement filed by the opponent doctor is concerned, it has been specifically admitted that he is aware of the WHO guidelines for treatment of P. Falciparum Malaria which prima facie shows that he was fully aware about which kind of treatment should be given in such kind of cases as per the WHO guidelines. It is pertinent to note that opponent doctor has not mentioned the entire text of WHO guidelines for treatment of malaria (2nd edition).

Quoting the entire literature, the court noted that Chapter 8 deals with treatment of severe P. Falciparum Malaria and chapter 8.10_4 deals with Exchange blood transfusion which reads as under:

8_10.4. Exchange blood transfusion:

There have been many anecdotal reports and several series claiming benefit for exchange blood transfusion (EBT) in severe malaria but no comparative trials, and there is no consensus on whether it reduced mortality or how it might work. The rationale for EBT has been variously proposed as:

  • removing infected red blood cells from the circulation and, therefore, lowering the parasite burden (although only the circulating relatively non-pathogenic stages are removed; this is also achieved rapidly with artemisinin derivatives);
  • reducing rapidly both the antigen load and the burden of parasite-derived toxins, metabolites and toxic mediators produced by the host; and
  • replacing the rigid unparasitized red cells by more deformable cells and,. therefore, alleviating microcirculatory obstruction.

Exchange blood transfusion requires intensive nursing care and a relatively large volume of blood, and it carries significant risk. There is no consensus on the indications, benefits and dangers involved, or on practical details such as the volume of blood that should be exellanged. It is, therefore., not possible to make any recommendation regarding the use of EBT

The court noted that Reading of above text would suggest that the treatment adopted by the doctor is not recognized by WHO after considering number of cases in which this treatment had been given. The opponent doctor has admitted in the written statement that as per WHO guidelines he has given treatment which would mean that he was well aware of the WHO guidelines.

The court also quoting the relevant literature noted that Even Centres for Disease Control and Prevention no longer  recommends the use of exchange transfusion (ET) as an adjunct to antimalarial drugs for the treatment of severe malaria

Noticing the averments made by the doctor that he had treated the patient as per the guidelines laid by WHO, the court stated,

“Opponent doctor is knowing about the WHO guidelines for treatment of P. Falciparam Malaria but he did not produce any documentary evidence in which EBT treatment has been given and the patient was cured which also unequivocally suggests that this treatment is totally outdated treatment.”

The bench asserted that none of the medicines suggested by WHO for the treatment of P. Falcipararn Malaria has been given to Madhuben by the doctor and outdated treatment has been given, which prima facie, amounted to negligence on the part or opponent doctor in treating the patient  hereby displaying deficiency in service, for which the hospital would be vicariously liable.

Opponent doctor though stated to be aware of the WHO guidelines resorted to an outdated mode of treatment for treating Madhuben which ultimately resulted in her death.”

On the compensation issue, the bench concluded,

”The opponents are directed to pay to the complainants Rs 13,60,0001- with interest (4) 9% p.a. from the date of complaint till realization and cost of the litigation quantified at Rs 10,000/.”

Attached is the judgement below

Source: self
13 comment(s) on Hospital, Doctor to Pay 13.6 lakh for Using Outdated Malaria Treatment

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  1. user
    Titus thundatharavilai May 19, 2018, 8:15 am

    An exemplary late judgement . This hospital also should be punished.Why there is 10+2+4+ 2 years = Qualified Registered Nurses not available to start IV and after to take care of the patient ?

  2. if a patient is heavy parasitemia and has not shown satisfactory response to standard faciparum malaria treatment i.e. inj artesuanate/quinine only in this kind of situation EBT is taken as an adjuvant treatment and not the primary treatment
    dr ahlawat

  3. user
    Dr Rajendra Dhaka May 12, 2018, 6:14 pm

    It appears and has also been documented in the forgoing case that the treating physician did not consider and totally omitted all primary/second line antimalarials in a stable patient, until last moment when even quinine had become contraindicated, in falciparum malaria with heavy parasitic load and complications.This would appear an outright flaw. His resort to EBT, to an informed patient, would stand vindicated as last resort empirical adjunct to all other measures, including available antimalarials for resistant malaria having been exhausted. Treating doctor has neither been represented by any doctor nor there is any expert medical member on the forum for professional jurisdiction.

  4. user
    Dr Ramesh Kumar May 12, 2018, 4:43 pm

    I feel that the treating doctor should have first administered either IV Artesunate or IV Quinine.
    Since it was a complicated Falciparum Malaria the Doctor should have explained about the bad prognosis.
    I personally don\’t agree with EBT as a modality of treatment for complicated Falciparum Malaria.
    It has been a negligence on part of the doctor. Patients should not be subject to experiments like guinea pigs.
    It\’s equally shocking that he chose to treat a complicated Falciparum Malaria case with EBT and not with Artesunate or Quinine.

  5. Court should have taken opinion of expert committee of professionals which will go into details of circumstances of death, appropriateness of treatment and whether there was any negligence or whether treatment was below expected level rather than interpreting medical literature by itself. Interpreting medical literature and determining cause of death is a complex thing. In western countries, all these cases are investigated by coroner who will discuss aspects of treatment with the expert in the field and determine its appropriateness. It\’s not fair for the doctors that non professional like judge without any expert knowledge will deliver such judgement recklessly.