PERAM VENKAYAMMA Vs. P.V.RAGHAVA SARMA

JUDGEMENT

(1.) The complainants 1 to 3 are wife and children respectively of the deceased Bayyapureddy ( hereafter referred to as deceased patient) have filed this complaint claiming compensation of Rs.20 lakhs on the ground that on account of wrong diagnosis and treatment given by Opposite Parties to the deceased patient, he died and they gave a treatment for dog bite instead for snake bite.

(2.) The facts as set out in the complaint are that on 16.4.2006 the deceased patient along with other farmers went to agricultural field and while returning in the evening at 5.00 PM he was bitten by a snake. After bringing him home he was taken to Nanda Hospital at Guntur for treatment but the doctor was not available so he was taken to OPs hospital for treatment appraising that the patient had snake bite. The doctors have commenced the treatment and they noted the details about the treatment given to the patient . As per the treatment details, the patient was treated for dog bite instead of snake bite. Though the doctors are not experts to undertake treatment for snake bite, however, to squeeze money they admitted the patient. The first complainant had paid a sum of Rs.7 lakhs for treatment. On the next day of admission, the OPs have referred the patient to IDA Gurnala for treatment for dog bite. The said hospital in turn referred the patient to Govt. General Hospital, Guntur, where, doctors have expressed that due to wrong treatment of dog bite the condition of the patient became worse advising to take back the patient. While returning home the patient succumbed. After taking home a report was given to the police who registered the FIR and sent the dead body to the post mortem. The doctor has opined that the death of the person was due to snake bite but not by dog bite.

(3.) OP. no. 1 filed counter affidavit denying the allegations made in the complaint. It is stated that he along with OP 2 have established Super Specialty Hospital at Guntur about 15 years back. After doing MBBS degree from JIPMER, Pondichery with distinction, did P.G. in Internal medicine from Post Graduation in Internal Medicine from PGI, Chandigarh in distinction. His wife is also a Neurologist having MD DM qualification. Their hospital is having latest equipments and recognized by State Government for reimbursement of the claims of Government employees. It is further stated that the deceased patient was admitted for treatment but it is incorrect to state that on 16.4.2006 the complainants have informed that the deceased patient had snake bite and the allegation that they gave wrong treatment for dog bite instead of snake bite are denied. The patient was brought to the hospital on 16th April, 2006 at about 9.00 PM and was discharged on 17.4.2006 at 12.00 Noon. The history given by the attendants of the patient was that the patient had burning micturition, pain in both lower limbs since four days and for the last one day the patient was restless, altered sensorium, hydrophobia, irritability and profuse sweating. On examination he was found to be restless having muscle twitching incoherent with dysphagia and hydrophobia, moving all four limbs was irritable. Pulse rate was 98/per minute, BP was 170/110, respiratory rate was 28 per minute, pupils were dilated and reacting. There was no evidence of external or internal bleeding. Ryles tube aspiration from the stomach was clear, urine through foleys catheter was also clear. A provisional diagnosis of brain stem encephalitis ' Rabies was made. It was a very serious condition which was explained to the attendants. Routine blood investigations were done along with ECG and CT scans etc. He was given antibiotics, Fortum and Metrogyl, , Decadron and anti Epileptics (Epsolin, Encorate), anti malarials (E-Mal), Fulsed, Deriphyllin, Nootropil, H2 Blockers ( Ranitidine) with supportive care like oxygen and IV fluids. There was suspicion of Rabies Enphalities, so the patient was referred to infective diseases hospital, Guntur. The common concept was that Rabies is caused by dog bite only . But the history in the present case was only less than 50% of the cases. Rabies is not only caused by dog bites but also by licks of dog, cats, rats, wolves, jackals, bats, rabbits, monkeys etc. From the time of animal licks or bites the person to the manifestation of the disease is called incubation period. The time taken by the pathogenic organism, ie., a Rabies virus to multiply in the human body to manifest its effects as the disease. The incubation period raises from 10 days to many years. Rabies disease effects nervous system leading to severe irritation and excitement of nervous system and muscles. and for that reason the patient developed severe cramps of muscles and symptoms of hydrophobia etc. Even ECG reveals the twitching artifacts. If there is no history of dog bite it cannot against rabies because (1) the bites of animals are generally remembered by people. But the licks are generally passed unnoticed and not remembered by the patient. (2) since incubation period is long most of time it is forgotten. It is further stated that there was no symptoms of snake bite exhibited by the patient. The symptoms of snake bite, which is a hallmark of haemototaxic snake bite and en-venamation.. There will be bleeding from gums, nose, mouth, bleeding from stomach manifesting as blood vomiting and also bleeding from the injection sites where it was bitten The snake bite will effect blood clotting mechanism and the blood does not clot at all. This is called DIC Disseminated Intravascular Coagulation/consumption coagulopathy ) DIC diagnosis can be made only when the patient is alive. It cannot be made after the death of the patient, i.e doing by post mortem. Even in the OPD ticket of the Government ID Hospital, Guntur also, , there is no symptom of snake bite given by the attendants or any bleeding manifestation noticed on examination. The doctors of Govt. ID hospital would have mentioned of the history of the patient and signs and symptoms so also fang marks and bleeding manifestations. In the Govt. ID hospital prescription it is mentioned that the diagnosis was ' encephalitis. There is no mention of snake bite at all. The Government ID hospital referred to the patient to Neurology dept of Govt. General Hospital, Guntur . And the said hospital had not referred the patient to a specialist to confirm snake bite which indicates that there was no signs and symptoms of snake bite at all.. The disease manifestations of snake bite and rabies are quite different. The Post mortem report was incorrect and unscientific. The Postmortem was done 18 hours after the death. It is noted in the Postmortem that blood was oozing when the internal organs were cut. It is a normal phenomena called Post Mortem fibronolysis leading to oozing of blood from all organs. This is a normal Postmortem finding. So on this basis alone it cannot be concluded that the patient died due to snake bite. There is no basis to state that there were fang marks on the body of the patient as noted in Postmortem report. One can say it as puncture marks. Nobody can say snake fang marks and there is a puncture mark made by needle. One cannot opine the puncture marks as snake bite marks. The RFSL gave opinion that no chemical poisonous substance was found in the blood. If the patient was bitten by snake even after three days of the death of the patient, snake venom would found in the Postmortem examination. So it cannot be said that the cause of the death of the patient was snake bite as per PM report. Before the deceased patient was admitted in the hospital on 16.4.2006 at 9 PM, prior to that he was taken to Nandana Hospital, Guntur. The other hospital are not impleaded as necessary parties. It is absolutely incorrect that the complainant had paid Rs.2 lakhs towards fees. The complainant applied to the government under Apadhbandhu scheme for payment of some compensation to her on the death of her husband. The complainant in order to apply for claiming compensation from Government she asked them to give a certificate as if the patient died of snake bite but it was refused. Thereafter the complainant requested the Ops to pay compensation of Rs.5 lakhs.