Honorary docs answerable8217;

On the same day, Bhanushali developed fever and a rash and was examined by one Dr D8217;Silva, who asked him to undergo a few investigations and stop the drug Augmantin.

He was subsequently admitted toLilavati on November 11 after the liver function tests showed abnormal results. Subsequently, he was examined by Dr Ramamoorthy and Dr M B Agarwal. A graft versus host reaction8217; due to blood transfusion was suspected. A skin biopsy along with HLA typing was done and medicines were started, but Bhanushali died on November 12, 1997.The cause of death was given as 8220;terminal cardiorespiratory arrest with blood transfusion induced graft versus host reaction with ischamic heart disease.8221;

The complainant says Bhanushali developed fever on November 3, 1997, which was associated with rash and chills. This is a symptom of graft versus host disease,8217; which was not identified by Dr Panda and no quick remedial action taken. When Dr D8217;Silva was contacted, he prescribed Crocin tablets without allegedly seeing the patient.

When the patient was taken for suture removal on November 7, he found the wound to be healthy and removed the sutures. But Dr Panda admits that Dr D8217;Silva noticed the patient had rash andcomplained of occasional fever. He asked the patient to undergo a few blood tests and a chest X-Ray, and asked him to stop Augmantin.

The patient did not contact Dr Pandya or D8217;Silva for the next two days, says Dr Panda. On November 10, 1997, when the relatives contacted Dr D8217;Silva, he was advised to undergo liver function test and based on the report, immediate admission was advised.

Bhanushali was admitted on November 11 and attended to by Dr Pandya8217;s team and Dr D8217;Silva. According to Dr Panda, the symptoms suggested malignant malaria, which could occur without positive blood test and hence, anti-malarial treatment was given. Senior physician Dr Ramamoorthy later confirmed the treatment.

Since the clinical condition was not improving, Dr Agarwal, who was consulted, suspected graft versus host reaction8217; due to blood transfusion for which a skin biopsy and HLA typing was done and special and expensive8217; drugs prescribed, which the relatives could not buy.

The hospital, in its affidavit, refutedcharges made by the complainant, and said the complaint did not disclose any cause of action against the hospital. Further, it says the death occurred due to the reaction, which got precipitated due to the transfusion. The blood bank from whom the blood was bought has not been made a party to the complaint. Dr Panda too said there has been no negligence in the patient8217;s treatment.

Negligence, the court said, 8220;can be an act of commission, that is, an act done by a doctor which a reasonable prudent doctor would not do under the situation or an act of omission which a reasonable prudent doctor would do under the circumstances.8221; Further, the standard of care desired is 8220;the reasonable care expected of the person who professes to possess certain skills.8221;

In the instant case, Dr D8217;Silva professed to be an expert/specialist and so the standard of care expected from him was that of an expert/specialist. When he saw the patient on November 7, 1997 the 15th post-operative day with rash and fever, he shouldhave thought of a graft versus host reaction along with a drug reaction.

8220;A reasonable prudent doctor who professes to be an expert in the field ought to have the patient immediately admitted, investigated and more importantly, kept under close observation. Nothing of this sic was done. This8230; amounts to negligence because a reaction of this nature in the late post-operative stage suggests that something is very wrong and therefore aggressive management of the condition becomes mandatory,8221; the court ruled.The judges also held that a hypersensitivity reaction to any agent, a drug or blood is per se not negligence but not identifying such a reaction and not doing what is required, by a person who professes to be an expert in the field, 8220;definitely amounts to negligence8221;. If the condition was identified in the early stage, something more constructive could have been offered to the patient, it ruled. 8220;By not admitting and keeping the patient under close observation on November 7, 1997, knowing full wellthat the patient had rash and fever since November 38230;he has not acted the way a reasonable prudent doctor should. This makes the services rendered by him deficient which according to us was responsible for the patient8217;s untimely death,8221; said the court.

Although Dr D8217;Silva is not a party in the case, the court ruled that the relationship of Dr Pandya and Lilavati Hospital is 8220;that of a principal and an agent, and that of Dr D8217;Silva and Lilavati Hospital is that of an employer and employee. By the law of vicarious liability, therefore, for all acts of omission and commission of the agent.. the principal will be liable.8221;