"The allegations of overdose of psychiatric drugs causing death of a patient, rejected." "A physician cannot be called as the expert witness on Neuroscience or Psychiatry". Adv. ROHiT ERANDE ©

 "The allegations of overdose of psychiatric drugs causing death of a patient, rejected."

"A physician cannot be called as the expert witness on Neuroscience or Psychiatry".

Adv. ROHiT ERANDE ©

Before : Hon. NCDRC.  FIRST APPEAL NO. 940 OF 2015

  RACHNA KHOSLA & 2 ORS. V/s. DAYANAND MEDICAL COLLEGE & HOSPITAL & 2 ORS LUDHIANA -141001 PUNJAB

BEFORE:  

  HON'BLE MR. JUSTICE R.K. AGRAWAL,PRESIDENT

  HON'BLE DR. S.M. KANTIKAR,MEMBER

  HON'BLE MR. BINOY KUMAR,MEMBER

Date of Judgement : 08 Feb 2022. 

Judgment Link :

http://cms.nic.in/ncdrcusersWeb/GetJudgement.do?method=GetJudgement&caseidin=0%2F0%2FFA%2F940%2F2015&dtofhearing=2022-02-08

Facts in short :

1. The deceased patient - a Civil Contractor, Mr. Sanchit Khosla was  having occasional minor psychiatric problems for 7 to 8 years. On or about 24.01.2011, he consulted one senior psychiatrist, Dr. Rupesh Chaudhari, - the “Opposite Party No. 2” at Dayanand Medical College & Hospital (DMC), for routine check-up. After examination, he advised the patient for admission in the hospital, but the patient and his attendants were reluctant for hospitalisation. 

2. It was alleged that, however, because of pressure and derogatory words used by the said Psychiatrist the patient was admitted in the psychiatric ward at DMC on 01.02.2011. The routine blood tests and ECG were found to be normal. It was alleged that the complications developed because of overdose of sedatives and anti-psychotic and as a result of which the patient died, though the condition of the patient was normal.  

3. The Hospital and the Doctors filed their written version and denied any negligence during treatment of the patient. I was contended that  during hospitalization, the patient was treated for the psychiatric problems as per reasonable care. The death was due to cardiac arrest but not due to complications of drugs or over dosage.  

4. The State Commission dismissed the Complaint. To challenge the dismissal, the Complainant filed the instant First Appeal. 

Held :

1. The NCDRC relied upon the expert committee report of Medical Board constituted at PGI report, consisting of a Psychiatrist, &  doctors from Department of Internal Medicine, Cardiology and Hospital Administration. The Board gave the opinion on following 3 specific points as under:-

1.         Whether the protocol was observed by OPs in respect of dose given to the deceased while treating him as a patient of psychiatry.

Opinion - the patient was suffering from a serious mental illness, most likely schizophrenia, for 11-12 years, and was admitted with frank psychotic symptoms, aggressive behviour and behavioral disinhibition. Specific psychotropic medicines given to the patient, which include antipsychotics and sedatives as part of the treatment package, are required for treatment of such patient as per present medical standards.

2.         If there was overdose whether the same resulted into complication resulting in the death of deceased.

Opinion - the patient was a diabetic, medical  Obese, and suffering from probable Obstructive Sleep Apnea, all of which are known medical risk factors for occurrence of adverse cardiac event. The doses of the antipsychotics and sedatives, as recorded in the Treatment Charts provided to the Board for scrutiny, are within approved ranges for the drugs used in such conditions and hence cannot be said to constitute an "overdose" as such causing death of the patient.

3.         Whether the requisite treatment was given to the patient after his condition became serious at 7 PM on 04.02.2010.

Opinion - The patient appeared to have received reasonable care and treatment as per the existing treatment protocols.

4.       The NCDRC rejected the expert opinion of the Physician produced  by the complainants. The Complainants  filed an affidavit with opinion of Dr. Vishwas Madhav Thakur, a private practicing Physician at Gurgaon that there was negligence during treatment of the patient . The said expert opined that the patient was given a cocktail of 6 medications (2 hypnotics and 4 antipsychotics) in the casualty itself. The 4 Antipsychotics were Injection Serenace (Haloperidol 5 mg), Injection Clopixol 100 mg, Tab Sizopin (Clozapine) 25 mg, Tab Sizodon Plus (respirodone). The two hypnotics drugs are Inj Lorazepam 4mg and Midazolam 5 mg. According to him, the diagnosis of schizophrenia and Obstructive Sleep Apnoea were without any supportive investigations. e further opined that there was no proper maintenance of record. 

It was observed that, Dr. Thakur, a physician, was not a subject expert in Neuroscience or Psychiatry, therefore, we do not give more credence to his opinion than the opinion of Board’s subject experts at PGI, Chandigarh.

5.       It was observed that after going through the records and medical literature, in our opinion the treatment given to the patient was as per prescribed standards. It is pertinent to note that , the patient was admitted in mental hospital at Amritsar in the year 2002 and 2003.  As per ICD-10 criteria, he was diagnosed as "Schizophrenic-Paranoid type with type II DM with severe family, personal, social and occupational dysfunction. The Patient    ran away from PGI during treatment. Moreover, it is pertinent to note that . 

6. The Commission relied upon the celebrated judgments of Hon. Apex Court , Jacob Mathew v. State of Punjab ((2005) 6 SCC 1) and Kusum Sharma & Ors. V. Batra Hospital (AIR 2010 SC 1050 ) and Medical Research Centre & Ors, which have laid down standard principles to establish medical negligence.  In the case of Achutrao Haribhao Khodwa & Others V State of Maharashtra & Others ((1996) 2 SCC 634 )  the Hon’ble Supreme Court held that:

“in the very nature of medical profession, skills differs from doctor to doctor and more than one alternative course of treatment are available, all admissible. Negligence cannot be attributed to a doctor so long as he is performing his duties to the best of his ability and with due care and caution. Merely because the doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chosen by him was acceptable to the medical profession.”

7. Lastly it was observed that  there was no deviation from the standard of practice and the doctors treated the patient as per the clinical signs of the psychiatric disease. The prescribed dose of medicines was well within the acceptable range. Thus, in our considered view, the patient did not suffer from the overdose of such medicine. However, during treatment, the patient suffered cardiac arrest, which caused his death. 

The Case deals with 2-3 important factors. The non-deviation of Standard Practice of treatment and maintenance of record has saved the Doctors. Further, one important factor, the Commission has observed that "A physician cannot be called as the expert witness on Neuroscience or Psychiatry". Another  point to be added in the list of  "What a MD Medicine can not do" . It is indeed sad that  earning member of the family, father to two kids lost his life so early. But every death cannot and should not lead to the presumption of negligence of Doctors. Does it ?

Thanks and regards

Adv. ROHiT ERANDE ©

Pune.