CHERIAN vs FATIMA MARY

-WE do not find any merit in this Appeal. The complainant''s husband went to the opposite parties for treatment for Asthma on 28.10.1996. He was administered an injection following which the complainant''s husband developed reaction and died. Hence, the complaint was made.

THE Lower Forum accepted the complaint and granted a sum of Rs. 2,00,000 as compensation. Aggrieved by the same, present Appeal is filed.

The opposite parties admitted clearly that the deceased John Selvaraj, the husband of the complainant, came to the hospital on 28.10.1996 for treatment of Asthma. It is also stated that one Dr. Prasad attended upon him and that they came to know from the patient that he was allergic to penicillin. Then it is stated that the Doctor advised the nurse to give him a test dose of Streptomycin and when the test dose was given, it is proved to be fatal. They also say that they took all steps to resuscitate but it was of no avail. Thus, it is clear that the complainant''s husband died at the hands of the doctors of the opposite parties.

IT is also not in dispute that the death was caused when injection was administered to him. Therefore, in such circumstances, it is a case where the negligence stands proved. From the records produced namely Ex. A5 series we find that the test dose was given at 11.00 a.m. There is nothing in the version to suggest that the doctor was present and monitored the administration of medicine. On the other hand, we find that it has been administered by the nurse. There is also nothing to show that the hospital was equipped with oxymeter, ventilator and other necessary equipments to deal with the case of emergency when patient develops such complications. The doctor who suggested the administration of Streptomycin is examined. From the Death Certificate issued we find that it is stated that the deceased died due to Anaphylactic shock. Anaphylaxis is defined in medical dictionary as a rather severe form of allergic reaction in which there is sudden collapse and sometimes death. Medical dictionary also points out that treatment is a matter of urgency. Therefore, it is clear that due to allergy and as a reaction to the drug that was administered the patient died. The document Ex. A5 says that 0.1 ml test dose was given. It is to be pointed out that this entry and the following six entries in Ex. A5 are in different handwriting. This entry is alone signed by somebody called Tamilselvi. We find at page 93 of this document that the name of the patient is given as John Selvaraj and it starts with the date 28.10.1996. It mentions the time at 11.00 a.m. It mentions the administration of certain medicines giving the time as 11.00 a.m., 11.30 a.m. and 11.40 a.m. While so, curiously enough in the previous page, it is mentioned as Inj. S.M. probably meaning Streptomycin 0.1 ml. was given at 11.00 a.m. In the version it is not stated what was the measure of test dose. From the prescription, Ex. A5, we find that 0.1 ml. was administered. According to the Nursing Manual, if the administration is Intradermal, 1 ml. calibrated on 0.01 ml. units tuberculin syringe with size of needle 26 or 27 gauge diameter and 3/8 to 5/8 inch length should be used. Stephanic''s Principles and Practice of Nursing speaks of it. It is stated in the medical literature that in the case of anaphylaxis, immediate injection of adrenalin 0.5 to 1 ml. of 1 : 1000 dilution will be of great value. It also makes a mention of the fact that the important immediate type of reactions are uriticaria and anaphylaxis (Precaution: A tray containing injection adrenalin, hydrocortisone and antihistamine niust be kept ready before administration of penicillin). Here, there is nothing to show that when the patient had already complained of allergy to penicillin and when a test dose of a medicine which is likely to have reaction was administered, basic precautions indicated in the Medical Textbooks were observed by the opposite party. In fact, it is not even stated that the doctor was present or that it is the doctor who attended upon the complainant''s husband or who administered the streptomycin. The case sheet containing a noting that patient is allergic to penicillin. While so, other broad spectrum antibiotics should have been given according to results of culture sensitivity test. The complainant''s case is that in spite of the complainant''s telling the opposite parties that the complainant''s husband was allergic to penicillin, he was administered Pencillin. That is of course disputed by the opposite parties. Dr. Prasad Cherian in his cross-examination says as follows: "Anaphylatic shock ''(Vernacular matter omitted)'' ''Anaphylatic shock ''(Vernacular matter omitted)'' Fatal Anaphylatic Shock (Vernacular matter omitted)". Therefore, it follows that what was administered was only penicillin and not Streptomycin. Further it is not the evidence of the doctor that Streptomycin is also likely to produce such reaction. The 1st opposite party namely the doctor who was examined does not say that Streptomycin is a safe medicine and that it does not produce any reaction. That is why the opposite parties have suggested test dose to be administered. Moreover, Streptomycin is suggested for treatment of Tuberculosis. Admittedly the complaint''s husband was not suffering from the same. While so, how could it have been advised. This only proves penicillin was given. It is also not stated that they administered adrenalin immediately or had it ready. The case sheet also does not contain any such entry. On the other hand, they have only administered Inj. Derriphilin, Decadran, Avil and Terramycin. It is also not the evidence that the hospital was equipped with a defibrillator. In the course of re-examination, the doctor has stated that anaphylactic shock would follow if penicillin or Streptomycin is administered or a test dose of the same is administered. If so, why should they link it. The appellants rely upon a letter said to have been given by the complainant under Ex. B2 on 28.10.1996. According to the complainant it was obtained by coercion. It is not known why and what was the necessity to obtain such a document on the very day itself if really the hands of the opposite parties were clean and that they took every step to resuscitate the complainant''s husband and what happened was beyond their control. There was no necessity to obtain such a letter from the complainant in the nature of the defence. There is no need to mention about the administration of test dose of Streptomycin. It is also to be pointed out that it is supposed to have been attested by number persons but none of them have filed any affidavit. Therefore, Ex. B2 is of on assistance to the opposite parties namely the appellants.

THIS is a case where the negligence is rampant and it speaks for itself. The death had taken place at the hands of the opposite parties. The Medical Books read that anaphylaxis is complication of penicillin as the spasm of smooth muscle and the dilatation of small capillaries take place due to presence of foreign protein in the serum which produces an excess of sensitive antibodies. In this connection, it is also to be pointed out that in Ex. A5 where the noting about the administration of test dose of Streptomycin is made in an out of context manner thereby suggesting that it has been done with a view to create a possible decence. Therefore, in the circumstances, there is negligence and deficiency in service on the part of the opposite parties in administering the test dose of penicillin in spite of objection of the complainant and her husband, the deceased and knowing well that he was allergic to penicillin. When a person is allergic to penicillin even a test dose may prove fatal. The document produced by the opposite parties namely the letter which is marked as Ex. A6 is of no aid to the appellants. If the death was not on account of the deficiency of the opposite parties, but was an inevitable complication of the administration of any drug, there was no necessity for them to obtain any such letter from the complainant. Therefore, the circumstances of the case clearly point out that in spite of the objections of the complainant that the patient was allergic to penicillin, the doctor has suggested the administration of test dose of penicillin and which has brought about the result. Therefore, we do no find any error in the order of the Lower Forum. The Lower Forum has taken into consideration the facts and has properly appreciated the same. Therefore, we do not see any reason to interfere with the same. Consequently this Appeal is dismissed with cost of Rs. 250 confirming the order passed by the Lower Forum. Appeal dismissed.