Starting treatment, especially for cases such as malaria, dengue, etc., in absence of a confirmed diagnosis should be done with due care and caution. This case explains why.
Irrefutable Facts
The patient suffering from fever was admitted to the first hospital, where treatment with T. Quinine (an anti-malarial) was started. Investigations performed reported negative for malaria, dengue, and typhoid.
When allergy to quinine was noticed, Inj. Falcigo (anti-malarial) was started.
A repeat investigation performed the next day was again negative for malaria. On the third day, due to the falling platelet count, the patient was shifted to the second hospital. However, due to unavailability of beds, the patient was transferred to its affiliate - the third hospital, where treatment for malaria was continued.
The patient’s platelet count was falling, and his condition was deteriorating. Therefore, the patient was again transferred back to the second hospital after two days, where he died after two days.
The death summary recorded the cause of death as ‘Fever with thrombocytopenia with multiorgan failure’.
The court appointed a committee of experts who opined that there was no negligence in this case.
The patient’s family sued the hospitals. It was alleged that the doctors of first hospital started T. Quinine and administered six doses despite investigations reporting negative for malaria. Moreover, when the patient developed an allergy to the drug, the doctors merely changed to another anti-malarial (Inj Falcigo) instead of withdrawing the same.
It was further alleged that doctors at the second hospital ”continued the game of wild guess while treating the patient” by continuing the treatment for malaria and dengue fever.
Doctor’s Plea
The doctors of the first hospital stated that even if investigation reports are negative “but there are symptoms of malaria even then quinine can be administered.” It was further stated that only one dose of 300 mg of quinine was administered and not six doses as alleged.
The second and third hospitals stated that they had treated the patient to the best of their ability, which was further confirmed by expert committee appointed by the court.
Court’s Observations
The court observed that there are times “when the root cause suffered by patient may not be diagnosed in spite of efforts of the treating doctors.” The court, relying on the expert opinion, held that administering six doses of 300 mg of quinine and shifting to Inj. Falcigo, a safer anti-malarial drug, when the patient got allergic to quinine, was “a standard treatment and not a case of overdose.”
The court held that treatment provided at all the hospitals was as per standard medical texts.
The case against all hospitals was dismissed by the court.
Prevention Is Better Than Cure
Starting presumptive treatment for an ailment based on symptoms without a confirmed diagnosis or inconclusive investigations is not always negligence. But there must be clear, compelling and convincing reasons for doing so. Treating the patient with anti-malarial drugs in case an area is declared endemic for malaria is one instance where presumptive treatment is acceptable. The doctors / hospitals must keep themselves regularly updated on government notifications in this regard.
Source : Sushma Dua & Ors. v/s Sir Ganga Ram Hospital & Ors.
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