Wrongful Use of TB-Drugs, not referring to Pulmonolgist: Senior Medicine Specialist slapped Rs 25 lakh Compensation
New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently held a South Kolkata-based senior medicine specialist guilty of medical negligence for wrongful use of anti-TB drugs on a patient resulting in acute liver failure.
Dr. Dutta from Kolkata has been directed by the Apex Consumer Court to pay Rs 25 lakh as compensation along with an interest at 6% from the date of filing of the case in 2017.
The top consumer court took this decision after taking note of the fact that the doctor started anti-tubercular as therapeutic trial, in spite of the test reports being negative for tuberculosis.
The matter goes back to 2015 when the complainant's husband, who had been suffering from fever, cough and vomiting, consulted the medicine specialist Dr. Dutta. Consequently, the doctor prescribed for several tests and after examining the test reports, he prescribed medicines of tuberculosis.
Allegedly, after taking the medicines for one week continuously, the patient's body colour became yellow and urine became deep dark and his condition deteriorated considerably. When the patient informed the same to the doctor, Dr. Dutta allegedly informed that it was a normal effect of the medicines and further advised the patient to continue the same.
As advised, the patient continued the medicines and his condition allegedly worsened day by day. Thereafter, the patient was admitted to KPC Medical College and Hospital, Kolkata and the treating doctor at KPC Medical College examined the test reports and the prescription of the medicines given by Dr. Dutta.
The treating doctor at the medical college, after going through the test reports, informed that the patient was not suffering from tuberculosis and as a result of the prolonged use of the medicines of tuberculosis, his liver was badly affected.
Consequently, Liver Function Test of the patient was conducted in 2015 and medicines were prescribed. Even though the patient remained admitted at KPC, his condition allegedly did not improve. Thereafter, the doctors advised to shift the patient to higher centre NRS Medical College. As per the complaint, the doctors at the Peerless Hospital and Research Centre also opined that due to prolonged use of medicines of tuberculosis. The patient died while undergoing treatment at Peerless. The Death Certificate mentioned the cause of death as "Sepsis with multi organ failure in a case of anti-tubercular drug induced. Acute fulminant liver failure". Thereafter, alleging negligence and irresponsible treatment provided by Dr. Dutta, the wife of the deceased patient filed the consumer complaint and demanded Rs 17019005 as compensation.
On the other hand, Dr. Dutta informed the Commission that on clinical examination, he was of the opinion that the patient was suffering from lower respiratory tract infection of the right side of the chest. He also informed about the medicines that he prescribed to the patient and about the fact that a Montoux test was advised by him and the report was negative. Since, the patient's condition did not improve tests like USG whole abdomen, Serum Amylase and Liver Function Test were prescribed.
Dr. Dutta submitted that LFT report was almost normal, USG showed SOL and fatty liver. Thereafter, CT Scan of the whole abdomen was prescribed, which showed haemangioma of liver with right sided pleural effusioh. Mycobacterium Tuberculosis PCR Mycosure TeSt. HRCT chest showed right pleural effusion with fibrotic densities of right lung with bronchiectasis in upper lobe with mediastinal lymph nodes. The report also suggested suspected tubercular ethology. Then he prescribed Anti-tubercular as therapeutic trial and started three drug regime with least hepatotoxic drug.
In this regard, the treating doctor also informed the Commission about premises on which he started the Anti-tubercular medicines. Apart form pointing out that India is still a country with TB endemic, he also referred to many sputum negative Mantoux negative tuberculosis, where only clinical suspicion and intuition yielded the desired recovery. Apart from this, the doctor before prescribing the drugs, allegedly, also took nite of the fact that the patient's LFT was almost normal.
The doctor further informed that it was quite unusual to develop hepatotoxicity due to Rifampin and INH within seven days. He argued that there may be some other factors requiring consideration. The doctor further denied any negligence conducted by him and claimed that he treated the patient honestly with his experience of over 30 years and ability as per best medical practice standards and ethics.
After taking note of the submissions and arguments made by both the parties, the Apex Consumer Court also perused the medical record including the drugs that were prescribed by the treating doctor. The Commission also took note of the LFT report dated 22.08.2015 showing that everything was normal and the report dated 24.09.2015 showing that the liver was damaged.
Referring to one drug Rifampicin, which was prescribed by the doctor, the NCDRC bench observed, "Medical literatures show that Rifampicin has common side effects of gastrointestinal, anorexia, nausea, vomiting, abdominal pain, hepatitis, reduced effectiveness of oral contraceptive pill and rare side effects of renal failure, shock or thrombocytoperia, skin rash, 'flu syndrome', colitis, pseudo adrenal crisis ostemalacia, haemolytic anaemia. lsoniazid has common side effects of Peripheral neuropathy, hepatitis, if age is above 40 years, sleepiness/lethargy and rare side effects of Convulsions, pellagra, joint pains, agranulocytosis, lipoid reaction, skin rash, acute psychosis."
In this respect, the Commission opined that the patient's liver got damaged because of the continuous consumption of Rifampicin Isoniazid and noted, "From the above evidence, it is proved that the patient, whose liver was normal on 22.08.2015, was found totally damaged in Liver Function Test Report dated 24,09,2015, due to continuous consumption of Rifampicin lsoniazid from 26.08.2015."
Further, the Commission noted that the doctor started the anti-tubercular as therapeutic trial in spite of the fact that the reports were negative for tuberculosis.
"In spite of test reports being negative for tuberculosis, Dr *** Dutta started anti-tubercular as therapeutic trial on his clinical suspicion. Based on clinical suspicion, the doctor has right to use expansive diagnostic test and procedure, which are necessary to reach appropriate diagnosis of the suspected disease. But the opposite party, instead of coming to a conclusion about the disease, started anti-tubercular as therapeutic trial ignoring test reports of negative tuberculosis," noted the Commission.
The NCDRC bench opined that the doctor should have referred the patient to pulmonologist instead of prescribing the anti-tubercular. Holding that the doctor committed gross medical negligence, the Commission noted, "If the medicines prescribed by him were not giving required result, he would have referred the patient to pulmonologist, instead of prescribing anti-tuberculars as therapeutic trial on clinical suspicion, which only permit expansive diagnostic test. When the patient reported to him on 05.09.2015 with yellowish discoloration of the whole body and complained high coloured urine, then again he committed negligence in visualising side of effects of anti-tubercular drugs and asked the patient to continue with same medicines, instead of stopping these medicines. From above evidence, it is proved that Dr **** Dutta had committed gross negligence in treating the patient, which resulted in his death."
At this outset, the Apex Consumer Court also referred to the Supreme Court order in the case of Jacob Mathew, where the top court bench had held that negligence is the breach of a duty caused by omission to do something which a reasonable man guided by those considerations which ordinarily regulate the conduct of human affairs would do, or doing something which a prudent and reasonable man would not do.
Therefore, the NCDRC bench directed the concerned doctor to pay Rs 25 lakh as compensation along with interest @6% per annum from December, 2017. Further, the Apex Consumer Court also granted directed Dr. Dutta to pay Rs 50,000 as costs.
"In view of the aforesaid discussion, the complaint is partly allowed with cost of Rs.50000/-. Dr Kabir Dutta (opposite party-2) is directed to pay Rs.2500000/- with interest @6% per annum from December, 2017 till the date of payment, within a period of three months from the date of this judgment," read the order.
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/ncdrc-rs-25-lakh-compensation-223498.pdf
