Wrong Diagnosis, Treatment of Steven Johnson Syndrome, NCDRC directs Ayurveda doctor to pay Rs 10 lakh

Although the bench agreed that the Ayurveda doctor was allowed to practice and prescribe allopathy treatment as per the notification dated 18.06.2004 issued by the State Government of Punjab, the top consumer court noted that the doctor failed on four counts- "Firstly failure to diagnose correctly the condition as SJ syndrome, but treated the patient for Measles. Secondly, the dose of steroid 4 mg Dexa was inadequate for this patient; the dosage should be calculated as per kg of body weight. Thirdly, for treatment of SJ Syndrome the appropriate drugs of choice would be Cyclosporine with Methyl-prednisolone and the dosage to be per kg body weight of the patient. Fourthly, there was delay and wrong referral of the patient to the physician instead of skin specialist."

The case concerned a minor patient and a Chandigarh based Ayurveda doctor, who was accused of medical negligence.

Back in 2009, the patient, a young girl of 12 years approached the treating doctor at his Chandigarh-based Nursing Home for complaints of fever, Cough and itching for the last 4-5 days and the patient also had a history of rashes for the last one day and she remained hospitalized till next date.

Also Read: Patient Dies of Fever due to Alleged Medical Negligence of Govt Hospital, Nurse; Rs 3 lakh Compensation directed

However, even after 13 hours of hospitalization, there was no relief from itching and so, the patient was referred to a specialist MD and was admitted to a Government Hospital, where she was diagnosed with Stevens-Johnson syndrome. She was discharged from the hospital after full recovery after a period of around 18 days.

The complainant accused the Ayurveda doctor of wrong diagnosis and wrong treatment which lead to rashes on the body of the patient beyond control. Further, it was alleged that even when the treating doctor was a BAMS practitioner, he prescribed allopathic medicines, which amounts to medical negligence.

Back in 2010, the District Forum, directed the doctor to pay Rs 1 lakh as compensation along with interest. However, when the matter came to be considered before the State Commission, the consumer court held that the doctor was entitled to prescribe and treat the patient with Allopathic Medicines, but held the Petitioner liable for medical negligence for wrong diagnosis and treatment.

Following this, the doctor and the nursing home approached the NCDRC, which upon perusing the medical record noted that the doctor was qualified in the system of Ayurveda medicine. On 03.03.2009, he recorded the clinical findings as " fever (1020F), Bilateral Conjunctivitis +ve, Stomatitis +ve and made the diagnosis as ? measles. He prescribed medicines the antibiotic (Acef 100mg), Boroglycerine, steroid – tablet Dexa 1 tid, and eye drop. On the next day, patient had more itching, therefore he stopped oral Dexa and gave injection Efcorline (Hydrocortisone) and thereafter, the patient was referred to the specialist doctor.

"Though, he was BAMS, but he was allowed to practice and prescribe allopathy treatment as per the notification dated 18.06.2004 issued by the State Government of Punjab. Therefore, there was no fault or negligence in his treatment," noted the NCDRC.

Referring to the issue of 'Cross-Pathy', the top consumer court noted, "various courts held that "cross-system" practice or "cross-pathy" is a form of medical negligence. Many State Governments have issued such orders and thereby permitted practitioners of AYUSH to prescribe allopathic medicines. Such State Government orders have been upheld as valid by the Hon'ble Supreme Court in its judgment in the case of Dr. Mukhtiar Chand and Others vs The State of Punjab & Ors . Thus, according to the Hon'ble Supreme Court judgment, Ayurveda, Siddha, Unani and Homoeopathy practitioners can prescribe allopathic medicines only in those states where they are authorized to do so by a general or special order made by the concerned state government in that regard."

"Few State Governments have authorized AYUSH doctor(s) it by some special order(s) to prescribe medicines of allopath, but in our view, that does not authorize the doctor to deviate from the standard of care which results into wrong diagnosis and prescribe wrong medicines. Thus, it should be borne in mind that it does not authorise to prescribe wrong medicines or make a wrong diagnosis. The Courts have also stated that prescribing allopathic medicines and misrepresenting these as traditional medicines is an unfair trade practice and moreover not explaining the side-effects of a prescribed allopathic medicine amounts to medical negligence. Finally, the Hon'ble Supreme Court has cautioned that employing traditional medical practitioners who do not possess the required skill and competence to give allopathic treatment in hospitals and to let an emergency patient be treated by them is gross negligence. Thus, in the event of an unwanted outcome, the responsibility is completely on the hospital authorities," further clarified the NCDRC bench.

Referring to the present case, the consumer court noted that the petitioner doctor was an Ayurvedic practitioner (BAMS) and he was eligible to practice Indian Systems of Medicines and Modern Medicines as per the Notification dated 18.06.2004, issued by the State Government of Punjab through its Department of Health and Family Welfare.

However, "On the clinical symptoms and signs, he failed to diagnose the serious disease correctly as S J syndrome, but he continued to treat the patient for Measles. He also failed to administer proper doses of steroids, the dose of steroid was far less. Such act of Petitioner amounts to lack of skill and reasonable standard of care," noted the NCDRC bench.

At this outset, the NCDRC relied upon the judgment of the Hon'ble Supreme Court in the case of Poonam Verma Vs Ashwin Patel & Ors, wherein the top court had held that "the doctor must not only be qualified, but he must also be registered with the appropriate Medical Council in order to practice as a doctor. A homeopath would not have knowledge about allopathic medicines and its drug actions, so administration of allopathic treatment by a homeopath would be proof enough to establish negligence".

Further, perusing the relevant medical literature, the consumer court noted that Stevens-Johnson syndrome and toxic epidermal necrolysis are severe, life-threatening mucocutaneous adverse drug reactions with a high morbidity and mortality that require immediate medical care.

After going through the treatment record of the Government Hospital in Patiala, the NCDRC noted, "It is apparent from the medical record that on 05.03.2009 she has prescribed Inj Decadron ½ amp BD which was inadequate dose. The Calsoft & Gention Violet locally was not an accepted reasonable practice. The standard protocol for treatment of SJ syndrome was not followed. The patient should have been treated with methyl prednisolone 50 mg (at least) per day and also Cyclosporine. The patient would have referred to higher institute i.e.PGI, Chandigarh for better management."

Thus, NCDRC held the Ayurveda doctor guilty and noted in the judgment,

"In our view, the Opposite Party No.2 failed on four counts- Firstly failure to diagnose correctly the condition as SJ syndrome, but treated the patient for Measles. Secondly, the dose of steroid 4 mg Dexa was inadequate for this patient; the dosage should be calculated as per kg of body weight. Thirdly, for treatment of SJ Syndrome the appropriate drugs of choice would be Cyclosporine with Methyl-prednisolone and the dosage to be per kg body weight of the patient. Fourthly, there was delay and wrong referral of the patient to the physician instead of skin specialist."

While deciding on the quantum of compensation, the bench noted that, "the quantum of compensation awarded by both the fora was Rs. 1 lakh with interest @ 9% p.a., which is certainly on the lesser side. The medical negligence in the instant case occurred in March 2009 and now we are in 2022. The patient at her young age of 12 years suffered very serious and potentially fatal SJ syndrome. It was the patient's sheer good luck that she survived in spite of such grossly inappropriate / inadequate treatment at every stage. Therefore, the patient/Complainant deserves enhanced just and reasonable compensation."

At this outset, the NCDRC referred to Supreme Court judgment in the case of Dr. Balram Prasad vs. Dr. Kunal Saha & Anr. and the recent case in Maharaja Agrasen Hospital Vs Master Rishabh Sharma.

"Based on the discussion above and the law laid down by precedents (supra), it would serve the ends of justice if the compensation awarded to be lump sum to Rs. 10 lakhs as just and reasonable. The Petitioners are directed to pay the Complainant Rs.10 lakhs within six weeks from today, failing which the amount shall carry interest @ 9% per annum till its realisation. The Revision Petition is so disposed with above direction," read the order passed by the NCDRC bench comprising of President R.K.Agrawal and Dr. S.M.Kantikar.

To read the NCDRC order, click on the link below.