NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION NEW DELHI REVISION PETITION NO. 1727 OF 2002 (From the order dated 1.7.2002 in F.A.No.76/2000 of the State Commission, Goa) Dr.V.K.Ghodekar (M.B.B.S.) Petitioner Versus Smt. Sumitra Pralhad Korgaonkar Respondent BEFORE: HONBLE MR. JUSTICE M.B. SHAH, PRESIDENT HONBLE MRS. RAJYALAKSMI RAO, MEMBER HONBLE DR. P.D. SHENOY, MEMBER For the Petitioner : Mr. M.N. Krishnamani, Sr. Adv., With Ms. A. Subhashini & Mr.A.V.Rangam, Advocates For the Respondent : Dr. Sanjay P. Korgaonkar, Auth.Rep. 22-5-2008 O R D E R
MRS. RAJYALAKSHMI RAO, MEMBER
The questions which
require consideration in this revision petition are:
(a) Whether
a medical practioner before prescribing a drug, which has side effects, should
be careful or not in informing the patient about its side effects such as
hypoglycemia etc.?
(b) Whether,
a doctor should give treatment for diabetes to a person who is alcoholic,
straightway on the basis of urine test report, without confirming by proper
pathological test that the patient is suffering from diabetes and thereafter
without informing the patient that the medicine should be taken before food and
alcohol should be avoided?
In our view, it is the
duty of the doctor, before prescribing diabetic drug, to inform the patient
about the side effects of a drug, particularly to an alcoholic person and he
should be informed that alcohol may increase sugar level and that diabetic drug
should be taken before food.
If is not done it will be
a deficiency in service.
This Revision Petition arises from the order dt.1-7-2002 passed by the
State Consumer Disputes Redressal Commission, Goa, in Appeal No.76 of 2000,
reversing the order dt.22-2-2000 of the District Forum, Panaji in Complaint
No.310 of 1993.
The facts of the case are
as follows :
The complainant Smt. Sumitra Pralhad Korgaonkar filed a petition before
the District Forum stating that her husband Pralhad Korgaonkar, aged about 45
years was taken to the opposite party
Dr. V.K.Ghodekar, Medical Practitioner at village Aldona on 23-2-1993,
as he was having chronic cough and cold. Dr. V.K.Ghodekar, the opposite party,
gave some medicines and asked him to come back on 26th February,
1993 with a sample of urine for test. Accordingly on 26-2-93, Shri Korgaonkar,
presented himself before the opposite party with the urine sample. The opposite
party who tested the urine mentioned that the urine sample showed sugar, which
is indicative of diabetes and prescribed one tablet of 5 mg. of Euglucon per
day for five days.
The Complainant stated
that after taking Euglucon tablet, for 3 days, Shri Korgaonkar, in the early
morning hours of 3-3-1993 at about 2.00 A.M., began sweating very much and had
convulsions and became unconscious. He
had to be rushed to the government hospital at Mapusa at 4.00 A.M., on 3rd
March,1993. At the hospital, soon after admission, he went into coma for about
4 days and thereafter recovered consciousness, but remained in the hospital for
40 days and was discharged on 10th April, 1993. He was advised to
take the treatment at home. He was again admitted in the hospital on 22-5-1993
for a few days. However, on 5-8-1993, Shri Korgaonkar passed away.
The complainant Sumitra
Korgaonkar, who is the wife of the deceased Korgaonkar, alleged that the
opposite party prescribed the tablet Euglucon a specific drug for diabetes
without ascertaining properly whether the patient was infact suffering from
diabetes. Medical literature was produced to show that Euglucon is a very
sensitive drug and needs to be administered with care and the dosage is to be
regulated carefully depending on the level of blood sugar. It is alleged that Shri Korgaonkar went into
coma due to hypoglycemia and that subsequent treatment in the government
hospital did not really help him to recover and that his death is directly
attributable to rash administration of Euglucon tablets by the opposite party.
The District forum which
heard the matter dismissed the complaint on the ground that no negligence has
been proved. In Appeal, however, the decision was reversed holding that ;
(a) In
the first instance the opposite party did not even ascertain whether the
patient was suffering from diabetes at all ;
(b) Without
so ascertaining, a specific and very sensitive anti-diabetic drug, dosage of
which has to be regulated with care, has been administered ;
(c) The
tablets were prescribed in a routine manner without advising the patient who is
an alcoholic that he should not consume alcohol and that the drug should be
taken only after the food ;
(d) That
the patient developed Coma because of the adverse effect of Euglucon.
(e) The
opposite party was directed to pay the complainant an amount of Rs.1,09,000/-
alongwith interest at 18% and he was also to bear a cost of Rs.5,000/-.
The
present appeal is filed by the doctor against the said order.
We heard both the
parties and carefully perused the evidence on record. The arguments of the
petitioner i.e., opposite party are: (a) that testing of urine sugar is one of
the first steps used by general practitioners like him in detecting
diabetes; (b) that sugar in the
urine indicates that the patient had diabetes; (c) that the dosage of Euglucon
prescribed was the minimum; (d) that
no evidence has been produced as to when and how the deceased consumed the
tablets of Euglucon; (e) that there is no evidence produced to link the
development of Coma on 3-3-1993 with the prescription of Euglucon given on 26th
Feb 1993; (f) that the patient in fact never came back to the opposite party
after taking prescription on 26-2-1993; (g) that no medical record of the
Government Hospital, Mapusa was produced to show as to what had transpired in
the hospital ; (h) that one of the random blood tests at the Govt. Hospital on
3-3-1993 showed that blood sugar as 185 mg confirms that the patient is a diabetic; (i) that the test which
took-place in August-1993 can be of no stretch of imagination be said to have
been caused by consumption of three Euglucon tablets of 5 mg each in February,
1993; (j) and that the decision of the District Forum was correct; and urged
that the order of the State Commission should be set aside.
The
petitioners son who is himself a doctor argued the case for the respondent
i.e. for Smt. Sumitra Pralhad Korgaonkar. He submitted ; (i) that for testing
whether a person is diabetic or not, testing urine for the same is not a
definite test to establish diabetes; (ii) that the urine test can be positive
for sugar under various other conditions including alcoholism; (iii) that the
opposite party, the doctor, knew that late Shri Korgaonkar was an alcoholic and
urine test can be false positive; (iv) that he was not suffering from any
serious disease other than chronic cough and cold when he went to the doctor;
(v) that there was no reason for him to go into a Coma soon within 4 to 5 days
after seeing the petitioner doctor; (vi) and that the development of Coma can
only be attributed to the consumption of tablets prescribed by the petitioner
doctor.
It is also argued that
while unfortunately no record of the government hospital, Mapusa, could be
produced because they were inadvertently destroyed or misplaced by the hospital
authorities, evidence of the attending doctors who also submitted themselves to
cross-examination is very much on record and it can be relied upon.
We heard both the parties
at length and after careful consideration of evidence on record we are of the
opinion that the petitioner (the opposite party) was totally negligent in discharge
of his duties and that there is a clear deficiency in service provided by him
for the following reasons :
The first question that
arises is as to why the petitioner doctor (opposite party) wanted to test the
urine of late Korgaonkar when he was brought in with the complaint of chronic
cough and cold. The petitioner himself answered this by saying that Korgaonkar
was smelling alcohol and was in a drunken state and he had suspected him to be
an alcoholic. He argued that this is what prompted him to ask the patient to
bring his urine for test after four days for possible diabetes.
The medical
literature produced on record shows that Euglucon is a drug belonging to
Sulfonyl Ureas. This is a specific anti-diabetic drug, which is required to
be administered after testing blood sugar levels. As a matter of fact, when
diet, exercise and weight reduction do not lower the blood sugar, then the
patient is put on drug therapy, with drugs like Euglucon and even then the
dosage needs to be adjusted periodically depending on the blood sugar levels.
The literature further shows that Severe Hypoglycemia(lowering blood sugar
levels) can be induced by Sulfonyl Ureas. These drugs increase release of
insulin. Therefore, these drugs like Euglucon are required to be administered
immediately after intake of food. Literature further shows that intolerance of
alcohol may occur in patient treated with Sulfonyl Ureas. Therefore the
patients are strictly advised to avoid alcohol while taking the drug. We find
that none of the precautions were given to the patient and the opposite party
merely prescribed Euglucon 5 Mg. for five days.
Secondly, the record of admission of the patient to the Asilo Government
Hospital on 3-3-1993 clearly shows that he was admitted at 4.00 A.M. on complaint
of convulsions. The patients relatives told the attending doctor, Dr. S.S.
Govekar, that the patient was not talking since 2.00 A.M., that he had
convulsions and frothing at the mouth, and that he had a similar convulsions at
8.00 P.M. on the previous night. They told the doctor that the patient had
taken one tablet of 5 mg. Euglucon for the previous 4 days. Dr. Govekar
confirmed these facts in his cross-examination, and stated that his diagnosis
was that of Hypoglycemia (fall in blood sugar level) due to consumption of
Euglucon, with chronic bronchitis. Dr. Govekar stated that he had taken a blood
sample to find out random blood sugar level, and thereafter administered 2
ampules of 24% glucose to restore the blood sugar level. This record at the time
of admission in the hospital is a contemporaneous record and has to be relied
upon.
It is clear from the
above that in the very first instance when the patient was brought to the
hospital in a comatose condition, the attending doctor felt that it is a case
of Hypoglycemia resulting from the administration of 4 tablets of Euglucon over
the past 4 days. This tentative diagnosis has been confirmed by the very first
blood sugar test taken on 3-3-1993 soon after admission of the patient in the
Asilo hospital, which showed the Random blood sugar at less than 50 mg. It is
clear that the culprit is Euglucon administered to a non-diabetic patient.
The third issue to be considered is whether the opposite party was right
in coming to the conclusion that the patient was having diabetes on the basis
of urine test conducted by him. The State Commission in its speaking order
quoted extensively from medical literature to show that the opposite party was
wrong to come to such conclusion.
Dr. Stephen Fajan and Dr. Robert Williams, MD, Professor of medicine,
University of Washington, in their book Methods and Criteria for Diagnosis of
Diabetes Mellitus stated as follows:
The
presence of Glycosuria never establishes the diagnosis, and blood sugar
determination must be made to confirm or eleminate the diagnosis of diabetes.
Renal and alimentary Glycosuria must be differentiated from diabetic Glycosuria
as discussed later. Other Meliturias and non sugar reducing substances in urine
which may give false positive reactions for glucose also must be considered.
In Davidsons Principle and Practice of Medicine, 15th
Edition, 1987, on page 467, it is stated ;
Glycosuria. the most serious disadvantage in
the use of urine test diagnostically arises from individual variations in renal
threshold, so that on the one hand some undoubtedly diabetic people have a
negative urine test for glucose due to raised renal threshold, and on the other
those with a low renal threshold give a false positive test. In order to
distinguish cases of this type from patients with mild diabetes, suitable tests
of carbohydrate tolerance is required.
A perusal of the above authorities on the subject show a unanimity of
opinion that blood sugar estimation and glucose tolerance test are mandatory
before confirming diagnosis. Further, the opposite party himself in his
affidavit-in-reply has admitted, the patient was suffering from chronic
alcoholism and all types of complications. He further admitted in his cross
examination that, sometimes the urine shows positive sugar test even though
there is no sugar. However, it is in certain cases like pregnancy and chronic
alcoholism etc.
Both the statements clearly show that the opposite party is aware that
the patient being alcoholic, urine test could show a false positive. The
opposite party clearly ignored standard medical practice and was further
negligent in discharge of his duty to the patient.
The last issue to be considered is whether administration of the
prescribed dosage of Euglucon can cause the damage that the patient suffered in
this case.
Dr. Dulari Pandodkar, who attended to the patient in the Asilo Hospital
has stated in her examination in chief; at the time of discharge of the
patient he had behaved abnormalities due to prior irreversible, neurological
damage suffered by the patient following drug induced hypoglycemic coma; In
cross; I say that one tablet of Euglucon per day given to a normal person can
cause hypoglycemia causing lack of supply of glucose to the brain resulting in
irreversible damage to the brain. This can also occur in patients taking normal
diet.
Similarly, Dr. M.R.Pendekar, Senior Physician at the Asilo Hospital
issued a certificate dt.25-8-1993 stating that Pralhad was diagnosed as a case
of chronic alcoholism with drug induced Euglucon hypoglycemic coma with
irreversible neurological damage. This opinion remained unshaken and
unrebutted in cross-examination. The deposition of the two doctors as well as
the initial diagnosis of Hypoglycemia by Dr. Govekar, discloses a unanimous
opinion that the patients hypoglycemic coma was induced by the drug Euglucon.
In view of the findings we fully
endorse the well-reasoned order of the State Commission and dismiss the
revision petition. There shall be no order as to costs.
..J
(
M.B. SHAH)
PRESIDENT
..
(RAJYALAKSHMI RAO)
MEMBER
.
(P.D. SHENOY)
MEMBER
rk.