M.S.BHATAMBRE vs BABU K.KOPLE

THIS appeal is directed against the order of District Forum, Latur in Complaint No. 147/96 wherein the appellant Dr. Bhatambre, has been directed to pay the compensation of Rs. 50,000/- to the complainant in respect of the death of his child of 7 months age, on account of negligence in the treatment of the child. The appellant/doctor has contended that this judgment cannot be sustained and that the order of compensation should be set aside because the District Forum has not considered the case by referring to the treatment, which the appellant gave to the child. The entire treatment has been given in pursuance of the established medical literature and there was, therefore, no question of negligence on the part of the appellant in administering the drugs and injections to the said child of the complainant. As against this, the complainant has contended that the appellant was totally negligent in treating the ailing child, that there was delay in giving blood transfusion, there was also administra-tion of wrong drugs and injections. THIS resulted in untimely death of the male child of the complainant and the compensation of Rs. 50,000/- can by no means, seems to be exaggerated and the order deserves to be confirmed.

IN order to appreciate this rival controversy, the few facts needs to be considered in this appeal. The complainant lost his 7 months old child. The complainant stays at Ahmedpur, District Latur and on 20.3.1996, the male child fell sick and hence the child was treated by 2 doctors, Dr. Tompe and R. Ugile at Ahmedpur. However, when the child did not improve but showed signs of deterioration in the health, the child was removed to the hospital of the appellant/Dr. Bhatambre at Latur. The appellant enjoyed the reputation as good doctor. He is also associated as Professor with the local Medical College and it is, therefore, persuaded the complainant to take the child to the hospital of the appellant. The child was admitted in the hospital at about 5.30 p.m. on 13.3.1996 and the appellant examined the child after admitting the child in the hospital. The appellant tried to diagnose the deceased child but according to the complainant, it seems that the diagnosis was totally wrong. The complainant spent monies in paying the fees for the treatment of child. On March 30, and 31st 1996, it is claimed that the appellant gave injection to the child and arranged the blood test and X-ray. However, the ailment of the child did not show any signs of diminishing. On 1.4.1996 Saline was given, so also blood transfusion was given but it is contended that none of the modes of treatment adopted by the appellant in retrieving the child from the sickness worked and that to the great misfortune of the complainant, the said child died at about 9.15 p.m. on 1.4.1996. The complainant vehemently contended that the doctors refused to give papers and that the treatment proceeded on wrong basis, which caused the death of the child. This has to be panalised by awarding compensation and the same has been done by the District Forum, Latur. The compensation of Rs. 50,000/- for the loss of a male child can on no reckoning seems to be on a higher side but on the other hand on the conservative side. If law permits, the compensation should be raised to a very higher figure in order to compensate the complainant who lost his son. IN the son he could see a bright future and future assistance to the family. The appellant contended that the entire allegations are wrong that the complainant, in order to damage the reputation of the appellant, approached the police and lodged the complaint. Fortunately, the treatment given was absolutely consistent with the valid medical literature and Civil Surgeon with the assistance of one Sr. Pediatrician Doctor examined the papers and clearly certified that there was no negligence in the treatment of the deceased child. The appellant has also given the details of the treatment, which according to him are consistent with medical practice. The child was diagnosed for Septicemia which is a serious ailment and the child suffered Septicemia since before the admission to the hospital. Both the doctors, at Latur gave the treatment and one mode of treatment adopted by doctors at Ahmedpur, was for maleria and the same was continued by way of abundant precaution. But when the symptoms of Septicemia were quite visible, the appellant adopted the treatment for Septicemia. To the details of contentions of the appellant, we shall come later but suffice it to say at this stage that the main stand of the appellant is that the treatment was fully consistent with the known mode of treatment for Septicemia and, therefore, the treatment of the appellant cannot be faulted and that the appellant should be absolved from the liability imposed on him in the order of the District Forum. In case the same liability is confirmed will cause a serious damage caused to the reputation of the appellant. The appellant is associated with several medical institutions. He is also on the teaching staff and this judgment under appeal would seriously damage his reputation vis-a-vis public institutions. It is, therefore, prayed that the order of compensation should be set aside. We, therefore, proceed to consider the reasons of the District Forum in awarding the compensation and the counter raised by the appellant in the written statement. The complainant has alleged that the doctor refused to part with the case papers and thereafter fabricated those case papers. To all these allegations, we shall turn later but for the moment, we may state that where the complainant alleges negligence in the treatment of the deceased child, the appellant on the other hand stoutly maintains that the treatment for Septicemia was consistent with the established mode of medical treatment. The treatment for malaria was by way of precaution because the doctor at Ahmedpur had started the treatment. There was no contradiction between these 2 treatments to defeat one for the benefit of the other.

We may turn to the reasons given by the District Forum for awarding compensation. In the first instance, the District Forum found that the child was given intravenous fluids because the child was diagnosed for Septicemia. Basipen 250 mg. and Omnatax 250 mg. injections were given. Even Larigo was also given. According to the District Forum, Latur, the Larigo is for treating maleria, whereas according to the doctor, although the child was diagnosed for Septicemia, the treatment of Larigo was called for malaria in view of apprehension of doctors at Ahmedpur. The complainant alleges that there was wrong diagnosis on the part of the appellant in respect of Septicemia. It is, therefore, contended that there was negligence on the part of the doctor in giving improper medicine. The other allegation is that it was the bounden duty of the appellant to carry out the blood culture and tested for the antibiotics so as to counter the seriousness of the ailment. It is further contended that the scrotal edema was also found. It was the case of major concern and further it is contended that the blood transfusion was given late, although the proceedings were initiated immediately and all this negligence on the part of the appellant has resulted in untimely death of the son of the complainant. It is also stated that in spite of seriousness dopamine, which is a steroid, a life saving drug was prescribed on 1.4.1996 and thus the seriousness of the ailment was not in the mind of the appellant. There was necessity to administer those drugs in time. The entire episode was over within a period of 3 days from 30.3.1996 to 1.4.1996.

WE may, therefore, turn now towards the defence raised by the appellant. In the first instance, the child was under treatment at Ahmedpur for more than 2 days, as can be seen by the treatment papers given by Dr. Tompe and Dr. Ugile. The doctors at Ahmedpur, viz. Dr. Tompe and Dr. Ugile by note dated 29.3.1996, requested the appellant to examine the child, who was suffering from Broncop pneumonia and anemia. It is quite clear that the condition of the child was in anyway happy and that the child was suffering from serious ailment. WE also cannot loose sight of the fact that Larigo was prescribed by the doctors at Ahmedpur and we find that this treatment is for malaria. According to Dr. Tompe, it seems that the child was diagnosed for maleria and by way of abundant precaution, Syrup Larigo was given and if that is continued by the appellant at his hospital, we do not see any negligence. It is nowhere established that Larigo was likely to be prejudicial to the health of the child. So far as the treatment of Septicemia is concerned, here we may, incidentally observe that the Civil Surgeon at Latur with the assistance of Pediatric has clearly certified that the treatment adopted by the appellant as described from the case papers was consistent and it cannot be faulted under the Brand name negligence. They were made to give those certificates on account of the complaint lodged by the complainant with the police and not by the appellant. This part of the evidence has been ignored by the District Forum and we see no justification in that regard. The entire version starts in favour of the appellant who is fortified with the certificate of Civil Surgeon who certified that the treatment was proper and no negligence can be read. On the other hand with this evidence, the onus shifted on the complainant to establish that the treatment adopted by the appellant was totally erroneous and that the doctor could be branded with negligence in the administration of medicine to the child. We, therefore, hold that the appellant had tendered medical literature, which shows that Septicemia and septic shock are dramatic clinical syndromes, which result from acute invasion of the blood stream by certain micro-organisms or their toxic products. Fever, chills, tachycardia, tachypnea and altered mentation are common acute manifestations of Septicemia. Now, in this case, we find that the child had fever and according to Dr. Bhatambare, there was pneumonia. All the same, the fact remains that the child had fever since 2 to 3 days and the symptoms were that of Septicemia. It was also clear that for Septicemia, antibiotics have to be initiated as soon as the diagnosis of Septicemia is made. Prior to the administration of antibiotics, blood cultures or relevant body fluids should be obtained but it may be emphasized that on detection of Septicemia the administration of antibiotics should not be delayed, in order to consider the report of the blood culture. It would be, therefore, seen that when the doctor started injections Omnatax and Basipen, those injections were relevant, in view of the medical literature, which is submitted on record. They are prescribed for Septicemia. This was besides the 2 syrups which were prescribed in the treatment by the doctors at Ahmedpur. As indicated, Larigo was continued in view of the same being prescribed by the doctor at Ahmedpur. From the medical literature, it is manifest that the blood culture report need not be awaited. The appellant has tendered the other legal literature which shows all precautions have to be taken while obtaining the blood transfusion but we shall come later. Suffice to say at this stage that the doctor started those injections, which were meant for treatment of Septicemia. We are, therefore, unable to agree with the findings of the District Forum that maleria was wrongly diagnosed and had malaria should not have been treated by Larigo when the symptoms were that of Septicemia as indicated above. We have stated that there were no contradictions, so as to defeat one by other.

REGARDING blood transfusion, it is stated that the blood transfusion commenced about 8 p.m. although the doctor advised obtaining blood after sending the blood of the deceased for analysis. The District Forum observed that whereas the internal haemorrhage was detected at about 5 p.m. on 1.4.1996, the actual blood transfusion at about 8 p.m. There was, therefore, gross negligence on the part of the appellant in giving the blood transfusion. In this regard, the medical literature has been tendered by the doctor. The system carried out by the other doctors also advised the blood test and blood transfusion. He has stated that obtaining blood from the Blood Bank is not so easy. It has to undergo various rules and those rules are prescribed by Ministry of Health and Family Welfare, by its Notification dated 15.12.1997. When we have gone through these rules, it is observed that they are bound to require some period for giving the blood to the victim. They cannot be lightly given go-bye the rules are meant to prevent other serious effects arising out of the wrong blood administration. We, therefore, find that if the period of 2 to 3 hours are spent in obtaining the blood from the Blood Bank, the said cannot be treated by way of negligence of the appellant. Doctor stated that the administration of blood is not administration of medicine. It is not the administration of drugs available on the shop. The blood transfusion is collection of blood from the patient, sending it to the Blood Bank, grouping and cross matching with the donor''s blood, bringing of the blood back to the hospital from the cold storage, thawing of the blood to the room temperature and then finally administering it to the patient. Therefore, time is consumed in obtaining the blood and administering the same to the patient. In this case, according to the appellant, no minute was wasted after the need for giving the need for blood transfusion was recognised and, therefore, looking to all these circumstances, we are of the view that no negligence can be attributed. The delay if caused in obtaining the blood was on account of the above rules, which had to be mandatorily observed by the person, requiring blood transfusion. No fault can lie at the door of the appellant in regard to this doctor for delay of blood transfusion. Doctor conveyed the requirement promptly. The delay is inevitable on account of the rules and hence we are of the view the delay of 3 hours relied upon by the District Forum in awarding compensation cannot be said to delay so as to impose the negligence on the appellant. We cannot lose sight of the fact that during this period, Saline was administered to the patient. There was, therefore, no neglect of the patient by the appellant in this period. According to the appellant, he was all along present by the bedside of the patient and there was, therefore, no argument available with the complainant to hold that he was negligent. We cannot lose sight of the fact that the blood culture reports are not available earlier. They are normally made available after 48 to 72 hours and, therefore, administration of antibiotics for Septicemia appears to be mandatory. The District Forum has wrongly relied that blood culture was delayed. There is no escape except to spend 48 to 72 hours in obtaining the blood culture report and, therefore, the appellant cannot be said to be negligence on the part of the appellant in the treatment of the child. Doctor administered injections and doses. The child was prescribed Injection ''Omnatax'' and was administered injection ''Haltex'' both being generically the same drug. There was thus no negligence on the part of the doctor in giving the proper treatment to the patient.

WE may generally observed that the health of a child was itself serious when admitted to the hospital. WE find from the record that doctor administered those medicines and injections, which were prevalent and supported by medical literature. The delayed blood culture report and the delay in blood transfusion are the delays, which cannot be attributed to the appellant doctor. They are the inevitable part of the procedure adopted for their administration. As indicated, rules are provided for examination of blood of the donor, rules are provided for administering the antibiotics when Septicemia is detected and, therefore, the approach of the District Forum in attributing the delay on the part of the appellant in treating cannot be treated as an act of negligence on the part of the appellant.

THE detailed version tendered by the appellant persuades us to hold that the appellant was no way negligent in treating the child at all. We cannot loose sight of the important fact that the child was treated at Ahmedpur for more than 2 days. At the later stage, when the situation became critical, the child was removed to the hospital of the appellant. We believe, had the child being treated by the appellant right from the beginning the event could have been averted. Unfortunately, the removal was delayed and the child was brought in critical condition at the hospital of the appellant. THE death of the child cannot be attributed to the appellant on account of the negligent treatment by the appellant. We may repeat that even the Civil Surgeon did not find any fault in the treatment given by the appellant. It is unfortunate that the complainant rushed to the police, losing sight of the important fact that he was damaging the reputation of the doctor, who has treated several cases of ailments of children. In very case entrusted to the appellant, he cannot give the assurance that the child would be saved. Ultimately, the health of the child is an individual affair. THE reaction of the child to the various medical treatments may be different and if in that contest, some victims fall pray to the ailments, the appellant or the doctors cannot be blamed. In this view of the matter, we are required to pass the following order. Order The appeal is allowed. The order of the District Forum is set aside. The original complaint is dismissed. If the appellant has deposited any amount, either in this appeal or in the District Forum, the said amount shall be returned to the appellant. In these terms, we dispose of the Appeal No. 949/97. Appeal allowed.