Tuberculosis

Tuberculosis

First Appeal No. 382 Of 2014   Sankar Kumar Mitra & Anr.  S/O Late Nalinakshya Mita   Versus   Dr. Indira Jha &  Ors.  Decided by the   National Consumer Disputes Redressal Commission  New Delhi  on  28 August,  2019 

 FACTS :The patient was a known case of seizure disorder which was diagnosed on 15.09.2000 at CMC, Vellore and she was under treatment and advised to take medicines (tablet) of Tegretol 200 mg  thrice a day and tablet Osteocalcium once a day.On 21.06.2006, the patient was admitted in B.R. Singh Railway Hospital, Sealdah, Kolkata and took the treatment from Dr. Indira Jha, patient was discharged on 09.08.2006, was diagnosed for  "seizure disorder, chronic hypertension, chronic liver disease and hepatic encephalopathy", was advised to attend the OPD of Gastrology and Neurology, thereafter. It was alleged that the opposite party no. 1 never followed the advice of Dr. T. P. Joseph given at CMC Vellore and Dr. Sital Ghosh, who treated her previously, despite the patient had handed over the previous treatment record (2000-2006) to the opposite party no. 1 at the time of admission. Patient was admitted in B. R. Singh Railway Hospital repeatedly from 11.09.2006 to 13.10.2007, was diagnosed as CLD hepatic encephalopathy and seizure disorder and portal hypertension, on 30.10.2007, the patient was once again admitted in the Railway Hospital for her severe back-pain, she was referred to Howrah Orthopaedic Hospital on 24.11.2007 and opposite party no. 2 opined that the patient was suffering from seizure disorder, dorsal spine, fracture with marrow oedema of D11 and D12 vertebra, tuberculosis and carries spine, suggested for the MRI of the dorsal spine and then the patient was referred to Railway Hospital for further treatment,  MRI was performed on 29.11.2007, which detected as fracture with marrow oedema in D11 and D12 vertebra,  spinal cord and canal were normal. According to the opposite party no. 2 the patient was suffering from tuberculosis and caries spine, thus he started anti tuberculosis drugs. Thereafter, the patient's condition was deteriorating, therefore, the patient was transferred for further treatment of tuberculosis at RNTCP (Revised National Tuberculosis Control Programme), Howrah, her treatment was started from 29.11.2007. The patient was admitted in the Railway Hospital on 06.12.2007 and was discharged on 12.12.2007, was again diagnosed for caries spine, CLD and portal hypertension and she was put on INH and PNZ and the other drugs were stopped. The patient again got admitted in B. R. Singh Railway Hospital on 22.01.2008 and was discharged on 25.01.2008. Thereafter, the patient again got admitted in the Railway Hospital on 08.03.2008 under the treatment of opposite party no. 4 and was referred to chest clinic, where opposite party no. 5  opined that the patient was suffering from miliary tuberculosis and CLD. The patient was advised to attend Health Centre Orthopaedic Hospital, Eastern Railway, Howrah. The said doctor stopped the neurological medicines without consulting any neurologist. The patient was again admitted at B. R. Singh Hospital, Sealdah on 20.09.2008 and she (patient) died on 19.10.2008. The patient was under the treatment of the opposite parties no. 4 and no. 1 (Dr. Sarmistha Mukherjee and Dr. Indira Jha). The cause of death was recorded in the death certificate as "Decompensated chronic Liver Disease with Hepatic Encephalopathy, Seizure Disorder, Sick Sinus Syndrome with permanent pacemaker implant with Old Fracture Spine". But during her life time, the patient was never treated for the said old fracture, rather the patient was sometimes treated for caries spine and sometimes treated for miliary tuberculosis at the whims of the opposite parties no.1 to 5 who preferred to juggle with the life of the said patient instead of making a perfect diagnosis of the disease of the patient and treating her accordingly.

FINDINGS: We note that the allegations of the complainants are in two fold. Firstly, it is the case of the complainants that the patient had been suffering from epilepsy and she was treated accordingly both at CMC, Vellore and also by Dr. Sital Ghosh, that the medicines prescribed at CMC, Vellore and by Dr. Ghosh for epilepsy were discontinued by the doctors at B. R. Singh Hospital, that no treatment was given for the neurological problems. On this point it is found from Annexure-A to the complaint at Page-20, that is, the medical report issued by the Department of Neurological Sciences, CMC, Vellore dated 15.09.2000 that it was diagnosed to be a case of temporal lobe epilepsy. Recommendations were:

"Tab. Tagretol 200 mg. thrice daily Tab. Osteocalcium 1 once daily."

Secondly, it was the specific contention of the complainants that the patient had never been suffering from tuberculosis and without proper investigations, anti-tuberculosis drugs were administered, for which her condition started deteriorating. On this point we find from the medical records of the patient that the MRI of dorsal spine was done on 03.07.08 and the impression was that there was partial collapse with marrow edema of D12 body. As per impression on MRI dated 25.06.2008 there were:

          1) D12  body partial collapse with marrow edema of D12 body

          2) Lumber spondylosis with degenerative disc disease

          3) L 4-5 and L5-S1 building disc with facet arthropathy causing central                        canal and neuroforaminal stenosis    

          4) L 1-2 and L 3-4 bulging disc.

MRI of dorsal spine dated 29.11.2007 shows the impression as "Fracture with marrow edema is seen in bodies of D11 and D12 Vertebrae."

HELD :According to the guidelines of tuberculosis of World Health Organization (WHO), the treatment in case of pulmonary tuberculosis and caries spine is the same. In my opinion, the patient was a known case of seizure disorder and elderly. She was under treatment of temporal lobe epilepsy and taking medicines Tegretol 200 mg and Osteocalcium 1. The medical record of the patient clearly reveals that in the Railway Hospital, the treatment was continued and the patient was treated for the other ailments, whenever she was got admitted in the hospital. The MRI report reveals the evidence of carries spice of D11 and D12 and it was diagnosed as tuberculosis spine D11 and D12. As per the RNTCP guidelines, the patient was started with anti "Koch's treatment, therefore, in my view, it was the correct and standard of practice for the treatment of such patient. Thus, complainants' allegation that the patient was not suffering from tuberculosis is not sustainable in this case. The treating doctors have taken all the necessary steps and relying on the investigation reports patient was given proper line of treatment. I do not find any deficiency or negligence in the treatment of the patient. However, the death of the patient was not due to anti tuberculosis drugs rather it was due to multiple ailments which she was suffering from.