eMedinewS
17th October 2014, Friday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and National Science Communication Awardee. Limca Book of Record Holder (CPR). Gold Medalist

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Senior National Vice President, Indian Medical Association; Member Ethics Committee Medical Council of India, Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Limca Book of Record Holder in CPR, Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04);
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

Stroke Update

Elective noncardiac surgery after acute stroke

In a nationwide cohort study from Denmark, which examined all patients aged 20 years or older undergoing elective noncardiac surgeries, a history of stroke was associated with risk of major adverse cardiovascular events (ischemic stroke, acute myocardial infarction, and cardiovascular mortality), post surgery, especially if time period between stroke and surgery was less than 9 months. The associated risk appeared stable after 9 months, but it was still high vs patients with negative history of stroke.1 Intravenous alteplase in acute stroke

According to a meta-analysis of individual patient data from randomized trials, administration of intravenous alteplase within 4.5 hours of onset of stroke, significantly improved the overall odds of a good stroke outcomes, with earlier treatment associated with bigger proportional benefit. The study evaluated individual patient data from 6756 patients in nine randomised trials comparing alteplase with placebo or open control. 2

Detection of atrial fibrillation after cryptogenic stroke

  • ECG monitoring with an insertable cardiac monitor (ICM) was superior to conventional follow-up for detecting atrial fibrillation after cryptogenic stroke. In the CRYSTAL AF trial, at 6 months, detection of atrial fibrillation was higher in patients with ICM vs control group; 8.9% vs 1.4%, respectively. At one year, atrial fibrillation was detected in 12.4% of patients in the ICM group vs 2.0% of patients in the control group. The trial included patients aged 40 years or older with no evidence of atrial fibrillation during at least 24 hours of ECG monitoring after ischemic stroke.3
  • Noninvasive ambulatory ECG monitoring of patients who had a cryptogenic stroke or TIA and no evidence of AF on routine monitoring for 30 days significantly improved the detection of atrial fibrillation and almost increased rate of anticoagulant treatment by 2–folds. In the EMBRACE trial, atrial fibrillation lasting ≥30 sec was detected in 16.1% patients in the intervention group vs 3.2% in the control group. The trial included patients aged 55 years or older, without known atrial fibrillation, who had had a cryptogenic ischemic stroke or TIA within the previous 6 months.4  

References

  1. Jørgensen ME, Torp-Pedersen C, Gislason GH, et al. Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery. JAMA 2014;312(3):269–77.
  2. Emberson J, Lees KR, Lyden P, et al; Stroke Thrombolysis Trialists' Collaborative Group. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 2014 Aug 5. Epub ahead of print.
  3. Sanna T, Diener HC, Passman RS; CRYSTAL AF Investigators. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med 2014;370(26):2478-86.

Gladstone DJ, Spring M, Dorian P, et al; EMBRACE Investigators and Coordinators. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med 2014;370(26):2467–77.

News Around The Globe

  • News that a second Texas Health Presbyterian Hospital nurse has Ebola  and that she was already slightly febrile when she boarded a flight Monday from Cleveland to Dallas –has heightened anxiety about the true risk of Ebola in the U.S. As events unfold, many healthcare workers, especially nurses, have expressed concern about their safety when treating Ebola patients.
  • Nina Pham, the Dallas, Texas, nurse who contracted Ebola from a Liberian patient, has received a plasma transfusion from an American missionary physician who became infected with the deadly virus while in Liberia, but recovered.
  • Both genes and environment influence psychiatric resilience to stressful life events, and both are largely stable over time, suggest the results of a large, long–term study published in the October issue of the British Journal of Psychiatry.
  • The US Food and Drug Administration (FDA) has approved for marketing nintedanib and pirfenidone for patients with idiopathic pulmonary fibrosis (IPF).
  • A study in Circulation: Cardiovascular Quality and Outcomes reports that patients with active inflammatory bowel disease (IBD) were at risk for poor outcomes after a first myocardial infarction (MI). In contrast, IBD patients who were in remission at the time of MI had no greater mortality risk than non-IBD patients.

Dr KK Spiritual Blog

The Five Interior Powers

To be in a state of happiness, bliss and ananda is what the ultimate goal of life is. Everybody is born with certain inherent powers, which if cultivated in the right direction will lead to inner happiness.

The ancient Shiva Sutra text talks about the concept of Shiva and Shakti. Shiva is silence, Shakti is power; Shiva is creativity, Shakti is creation; Shiva is love, Shakti is loving.

In computer terminology, Shiva is the knowledge or the information and Shakti is the operational software. Shiva and Shakti both together form consciousness, in other words, the soul.

Shiva sutra – teaching about Shiva – describes five inherent powers of Shakti which everybody is born with. These are ”Chitta Shakti”, “Ananda Shakti”, “Gyan (Gnana) Shakti”, “Ichha Shakti” and “Kriya Shakti”.

Kriya Shakti is the one which is most visible. Kriya is not same as karma. Karma is action born of cause and effect. Kriya Shakti is at the level of body and mind.

Ichha Shakti is the inherent desires which control the mind. Gyan Shakti is the inherent desire to learn and is at the level of intellect. Both Ananda and Chitta Shakti are at the level of consciousness and represent the desires or aim to be blissful.

These five powers also decide the needs of a person, which can be at the level of physical body, mind, intellect, ego or the soul. The needs activate the Shakti which in turn leads to action. The purpose of life should be to direct the needs and the Shaktis towards the soul and not towards the ego. The power of Kriya Shakti should have all the actions directed towards the soul; Gyan Shakti should be directed towards the knowledge of the true self; Ichha Shakti towards the desire or intention to unite with the self; Anand Shakti and Chitta Shakti towards the awareness of God and to experience the bliss of God.

All thoughts, speech or actions in life should be directed on two basic goals: providing happiness to others and achieving self-happiness. Every action and relationship in life should involve these five powers to attain inner happiness.

Most computers in the body require a key to get activated and the key in the case of Shakti is “intention or intent”. Intentions are something, which are under the control of a person, or one can practice control over them.

“Intention” always requires the association of its buddy “attention” with it. Attention is the focus of action on that particular intention. The combination of intention and attention can change perceptions of life and ultimately change the reality. It has been an old Upanishad saying that you are what your thoughts are. Right intention leads to the right thought; the right thought to right action; the right action to the right habit; the right habit to the right character and the right character leads you to what you are. The punch-line, therefore, is to have right intention which should be directed towards one of the five Shaktis to acquire spiritual well-being.

Health is not mere absence of disease but a state of physical, mental, social, environmental and spiritual well-being. Spiritual well–being now has been added as the fifth dimension of the health. It has been said that the body is the largest pharmaceutical armamentarium in the world and has the capacity to produce each and every drug available in the universe. This is based on the fact that no drug can go into the body without a receptor. The very fact the body has a receptor for every drug means it has the capacity to produce that drug.

All yogic paths to liberation are also directed towards these Shakti. One adopts the path of karma by activating Kriya Shakti, Gyan Marg by activating Gyan Shakti and Bhakti Marg by activating Ichha Shakti.

Faulty lifestyle also involves distractions of three of these powers: Ichha, Gyan or Kriya Shakti.

Correct lifestyle involves the correct use of Kriya Shakti in doing actions, correct use of Gyan Shakti by acquiring knowledge about self and healthy behavior and correct use of Ichha Shakti by learning the dos and don’ts of life and controlling the mind towards various addictions of life, which can be addition of food, sex, drugs, alcohol, smoking, sleeping, not walking and or eating faulty Rajsik cum Tamsik high refined carbohydrate diet.

Inspirational Story

A harsh word

A woman bought eggs and butter from a farmer who had a fine reputation not only for the quality of his products, but also for his promptness of delivery. Then one day, when she was expecting guests, he failed to come. On the next delivery, she spoke harshly to him. At the end of her tirade he said quietly, "I'm sorry if I caused you any inconvenience, but I had the misfortune of burying my mother yesterday."

Ashamed, the woman determined never to speak harshly to anyone again until she fully understood the cause of the delay.

Often we never care for other travails and traumas. Like a frog in the well, our feelings remain confined to our milieu. Even a farmer has his own priorities. Sometimes, we do not empathize with others. What if we had been stricken with some tragedy and someone callously chastised us.

Rabies News (Dr A K Gupta)

What are the precautions to be taken while administering RIGs?

  • Patient should not be on an empty stomach.
  • The RIGs vial taken out from the refrigerator should be kept outside for a few minutes to warm it to room/body temperature.
  • While infiltrating RIGs into the bite wound, care must be taken to avoid injecting into blood vessels and nerves.
  • While injecting into finger tips, care must be taken to avoid compartment syndrome.
  • All emergency drugs and facilities for managing any adverse reactions must be available.
  • For ERIG, keep the patient under observation for at least one hour after ERIG administration and then send home.

RIGs can be infiltrated even to already sutured wounds without disturbing the sutures.

Cardiology eMedinewS

  • New research has revealed a "continuous and independent relationship" with fractional flow reserve (FFR) and clinical outcomes such that lesions with low FFR values benefit the most from coronary revascularization and lesions with higher FFR values receive less benefit from either PCI or CABG surgery. The findings are published in the October 21 issue of the Journal of the American College of Cardiology.
  • A subgroup analysis of patients in the MADIT–CRT trial suggests that normalization of LVEF to greater than 50% in response to cardiac resynchronization therapy results in a very low risk of ventricular tachyarrhythmias (VTAs) and therefore no need for the implantable cardioverter–defibrillator (ICD) in the defibrillating cardiac-resynchronization–therapy (CRT–D) device. The analysis was published October 9 in Circulation.

Pediatrics eMedinewS

  • Evaluation of waist-to-hip ratio may be a useful tool to indicate risk for developing metabolic syndrome and diabetes in children and adolescents, suggested a new study presented at the American Academy of Pediatrics’ Annual Meeting.
  • Maternal sociodemographic factors significantly influence dietary patterns among infants, which in turn affects infant growth and development, suggests a new study. Researchers noted that mothers with non–Hispanic black race/ethnicity, lower education, and low household income were more likely to feed their infants foods high in sugar, fat, and protein that is linked to fast gain in infant adiposity and slower growth in length. The data are published online October 13 in Pediatrics.

Quote of the Day

  • Do not spoil what you have by desiring what you have not; remember that what you now have was once among the things you only hoped for. Epicurus

IMA NEWS

Noida police have booked two persons for allegedly cheating MBBS aspirants out of lakhs of rupees after promising to get them admission into King George Medical College, Lucknow. The FIR was lodged following complaints by a number of students from different states and the case has been handed over to the UP police crime branch for further investigation.

swachh bharat

Wellness Blog

Can one drive after one peg of alcohol?

Several studies have confirmed that consuming one or two drinks increases the risk of injury. No safe level of alcohol use exists for the use of potentially dangerous equipment. Exposure to alcohol is measured in blood alcohol concentration (BAC) rather than drinks per day or week. BACs of 0.02 to 0.05 percent impair the ability to operate motor vehicles; this level of blood alcohol can occur with even a single drink. The legal BAC limit for driving is 0.03 percent.

This corresponds to approximately four drinks for a 200 pound man, but only 2.5 drinks for a 150 pound woman.

  • The risk of involvement in a collision while driving doubles at a BAC of only 0.05 percent.
  • Simulated driving ability is impaired with BACs as low as 0.02 percent.
  • The risk of driving accidents is greatest in the first two years of exposure to alcohol.
  • For pilots the BAC offense level is 0.04 percent.
  • Alcohol is involved in one–half to two-thirds of all homicides, at least one-half of serious assaults, and more than one-quarter of all rapes.

ePress Release

Day two of Heart Care Foundation of India’s annual flagship event, Perfect Health Mela celebrates the importance of Swachch Bharat, Swasth Bharat

Key events included the cultural and eco festival which were attended by over 3000 school students

New Delhi, 16th October 2014 –The microcosm and macrocosm have sayings from the Upanishads, environment affects the body and the collective consciousness of the people affects the environment. Heart Care Foundation of India, a leading National non-profit organization committed to making India a healthier and disease free nation inaugurated the eco and cultural fest- a series of inter school competitions aimed at educating children about the importance of keeping the environment clean to reduce the occurrence of diseases on the 2nd day of its annual flagship event-The 21st MTNL Perfect Health Mela being held from Oct 15 – 19, 2014 at the Talkatora Stadium, New Delhi. The Inauguration was done by renowned sitar Player Prateek Choudhury.

More than 3000 students participated in various competitions started by Dept. of Environment Govt. Of India and was coordinated by Birla Vidya Niketan.  The competitions included Classical Music and dance, Eco model display and Nukkad Natak

All schools students were educated about the importance of health and hygiene and trained on hands only CPR 10 for revival after sudden cardiac arrest.

The Hands only CPR 10 formula taught was – To revive someone after a sudden cardiac death, within 10 minutes of the cardiac arrest (earlier the better) for 'at least' 10 minutes (longer the better) compress the center of the chest of the victim, continuously and effectively, with a speed of at least 10 x 10 (i.e.100) per minute.

Addressing the event Padma Shri, DST National Science and Communication and Dr. BC Roy National Awardee and the President of the Heart Care Foundation of India, Dr. KK Aggarwal said “Heart Care Foundation of India is committed towards raising health awareness and making the country a disease free nation. Over the years the number of dengue, typhoid and malaria cases being reported in the country has increased. One of the primary reasons for this being improper disposal of waste, open defecation, unhygienic habits and the inability of the citizens to keep their environment clean. It is extremely important to educate students from the very start about the importance of health, hygiene and sanitation to help prevent disease occurrence in the future. It is indeed a pleasure to see so many young students coming together and helping raise awareness about this issue”.

Adding to this, Dr. Mohan Nair and Dr. T. S Kler Sr. Cardiologist ins a joint said “Health education and lifestyle changes should start right from school age. The seeds of heart blockages are burrowed while a person is still in the growing stage. Out of 21 meals, cheating should be allowed in two meals and remaining 19 meals children should be given safe and healthy food with no trans fat, refine carbohydrates and no bad animal fat.”

School children were also see taking a pledge to say no to fire crackers this Diwali to keep the environment clean. To know more about the mela please visit www.perf ecthealthmela.com

emedipicstoday emedipics

Day two of Heart Care Foundation of India’s annual flagship event, Perfect Health Mela celebrates the importance of Swachch Bharat, Swasth Bharat
Key events included the cultural and eco festival which were attended by over 3000 school students

mela_brochure
SAIL


21st MTNL Perfect Health Mela 2014
SAIL

Self-Assessment-Quiz

 

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Communication skills for Health care Professionals

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MTNL Perfect Health Mela

Heart Care Foundation of India, a leading national non–profit organization committed to making India a healthier and disease-free nation announced the upcoming activities of the 21st MTNL Perfect Health Mela scheduled to be held from 15th – 19th October 2014 at the Talkatora Indoor Stadium in New Delhi.

Sameer Malik Heart Care Foundation Fund

The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number +91 9958771177 or by filling the online form.

Madan Singh, SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund, Post CHD Repair

Deepak, SM Heart Care Foundation Fund, CHD TOF

Total CPR since 1st November 2012 – 96458 trained

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

CPR 10 Success Stories

Ms Geetanjali, SD Public School
Success story Ms Sudha Malik
BVN School girl Harshita
Elderly man saved by Anuja

CPR 10 Videos

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VIP’s on CPR 10 Mantra Video

Hands–only CPR 10 English
Hands–only CPR 10 (Hindi)

 

IJCP Book of Medical Records

IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.

If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us on :

 

Dr Good and Dr Bad

Situation:A diabetic patient was on aerobic exercise protocol.
Dr Bad: Continue it.
Dr Good: Add resistance training also.
Lesson: According to a study published in the Journal of the American Medical Association, people with diabetes should mix aerobics with weight training to get the best results in lowering their blood sugar levels.

Make Sure

Situation:A patient with renal failure came to a doctor.
Reaction: Oh, my God! Why was he given painkillers?
Lesson: Make sure to remember that most painkillers (barring nimesulide) are not kidney–friendly drugs.

eMedinewS Humor

Funny meanings...

MARRIAGE: An agreement wherein a man loses his bachelor's degree and a woman gains her master's.

Twitter of the Day

Dr KK Aggarwal: Shorter acting calcium channel blockers linked to breast cancer
Dr Deepak Chopra:No regrets and no anticipation, just this moment fresh and as is

eMedi Quiz

Prevalence of HIV infection in India is:

a.1.8 million
b.2.3 million
c.4.5 million
d.6.7 million

Yesterday’s Mind Teaser:All the following are related to legal responsibility of an insane person except.

1. Mc Naughten's rule
2. Durham's rule.
3. Curren's rule.
4. Rule of nine.

Answer for yesterday’s Mind Teaser:: 4. Rule of nine.

Correct answers received from:Daivadheenam Jella, Dr. B. B. Aggarwal, Dr . Raghavendra Singh, Dr Jainendra Upadhyay, Najib Khatee, Dr Avtar Krishan, Dr.K.V.Sarma, Dr.K.Raju

Answer for 15th Oct Mind Teaser:2. 1 lakh i.u./m.l

Correct answers received from: : Najib Khatee, Dr Avtar Krishan

Send your answer to email

medicolegal update

(Dr. K K Aggarwal, Padma Shri and Dr. B C Roy National Awardee; Editor eMedinewS and President Heart Care Foundation of India)

Streptokinase can be given by MBBS doctor

Facts

  • The petitioner/complainant Parwati Devi is the widow of Shri Ram Prasad Gupta, who was a patient of hypertension and diabetes mellitus (DM) and was on regular treatment for the said disease. 
  • The said Ram Prasad Gupta developed dyspnea with cough and mild chest pain on 15.04.2008, for which he was admitted to Regional Hospital, Dhori under Central Coalfields Limited (C.C.L.) where the OP Doctor R.N. Jha was on duty on 15.04.2008 at 3:30 AM. 
  • The said doctor examined the patient and diagnosed DM with hypertension with acute Myocardial Infarction with CCF. 
  • The Doctor gave injection streptokinase to the patient, which led to Cerebral Haemorrhage.
  • When the condition of the patient worsened, he was referred to Bokaro General Hospital (BGH) on the same day at 8:30AM.  The patient, however, died at BGH on 25.04.2008 at 3:00AM.

Allegations

  • The said doctor had indulged in medical negligence by giving injection streptokinase, because the said injection can be given only by a specialist Doctor, whereas the OP Doctor was holding a MBBS degree only. 
  • Further, the said hospital was not properly equipped to deal with said kind of cases, as there was no provision for CCU or CT scan in the said hospital. 
  • It is also alleged that the injection streptokinase is given only when the blood pressure (B.P.) of the patient is less than 160/100; however, in this case the BP was 210/130.
  • The complainant filed the consumer complaint in question, seeking direction to the OP/ Doctor to make payment of Rs. 10 lakh as compensation and Rs. 6000/- as cost of treatment.

 Defense

  • The said doctor was a permanent employee of the Central Coalfields Limited (CCL) and like other Doctors, he had to perform emergency duty as per the roaster issued by the Hospital.  When the husband of the complainant was admitted in the Hospital on 15.04.2008, he was on duty to handle the case in the emergency. 
  • Before starting the treatment, he had advised the attendants of the patient to shift him to the BGH, given his deteriorating condition.  However, the said attendants/relatives requested him to continue the treatment. 
  • The patient was then admitted and on the basis of previous history, as disclosed by the patient and his son and also on clinical examination, it was detected that the patient was suffering from Myocardial Infarction with heart failure. 
  • The Doctor has stated that it was wrong to say that streptokinase was administered when the BP was 210/130.  The said medicine was purchased from a chemist shop which opens only after 6:00 AM.  The said medicine was given when the BP was around 150/90. 
  • The Doctor has denied the allegations leveled in the complaint, stating that he treated the patient to the best of his ability and it was not necessary that the injection streptokinase could be given by a specialist doctor only.

 District Forum Judgment
The District Forum after taking into account the evidence of the parties, allowed the complaint and directed payment of Rs 12,000/- as compensation and Rs. 3000/– as cost of litigation by Doctor to the complainant. 
Appeals
Two appeals were made against this order – one by the complainant Parwati Devi and the other by the OP, Dr. R.N. Jha. 
The State Commission vide impugned order dismissed the appeal filed by the complainant, but allowed the appeal filed by the OP Doctor, consequently, dismissing the consumer complaint in question.
Arguments
Complainant

  • That injection streptokinase is given when the BP of the patient is less than 160/100 mm of Hg.  However, in this case, the injection was administered at 3:30AM when the BP of the patient was 210/130.
  • It has been stated in the report given by Doctor Neeraj Prasad, Department of Cardiology, Abdur Razzaque Ansari Memorial Weavers Hospital – Apollo Hospital group that streptokinase is a life-saving drug, which is given within two hours of the onset of symptoms.  It is given when the BP is less than 160/100 mm of Hg.  It has also been stated by Dr. Prasad that all qualified doctors and even trained paramedics can give streptokinase. 
  • Learned counsel argued that the original record of the Hospital had not been made available to them and there was over-writing/ manipulation in the record. 
  • The learned counsel stated that there was overwriting in the medical prescription.
  • As observed by Doctors of BGH, the patient had died due to Cerebral Haemorrhage, which occurred due to the streptokinase injection given at high BP.

Defense

  • The allegation of medical negligence on the part of the OP/Doctor was not substantiated from the facts on record.
  • The medical negligence could be attributed only, if the diagnosis done by a Doctor was wrong, or the plan of treatment was wrong or the treatment administered to the patient was wrong in any manner.  In the present case, none of these factors were there and hence, the charge of medical negligence was not established. 
  • The order passed by the State Commission was, therefore, in accordance with law. 
  • The learned counsel also stated that the patient was under the supervision of a team of four Doctors, when the said injection was given
  • Moreover, the onus to prove that it was a case of medical negligence, was on the complainant.
  • The patient had been shifted to the B.G.H. within a period of 4 to 5 hours from admission in the CCL hospital.  The OP had advised shifting to that hospital, when the patient was brought before him, but the relatives of the patient were not prepared to take him to BGH. 
  • The learned counsel stated that the injection in question had been purchased around 6 AM from the Chemist shop.  The said shop opens for business around this time only.  Referring to the allegation of manipulation in the records etc., the learned counsel stated that relevant record was always kept in the hospital. 
  • If the complainant is levelling any allegation regarding forgery in record etc., they should have been impleaded the hospital as necessary party.

Complainant Cross Examination

  • The learned counsel for the petitioner replied that as per the usual practice, the medicine is given from the stock of the hospital and later on, the same is replenished after making purchase from the chemist shop. 
  • The learned counsel further stated that the allegation of making forgery in the record had not been controverted by the other party. 
  • Moreover, the four doctors said to have been present during treatment belonged to the same hospital.

Final Judgment

  • From the facts on record, it is evident that the patient was in a serious condition when he was brought to the CCL Hospital, Dori. 
  • It has been stated by the OP/Doctor in the written statement filed before the District Forum that before starting treatment of the patient, the OP/Doctor had advised to shift the patient to BGH for better treatment.  However, the attendants accompanying the patient insisted that the treatment should be started at the CCL Hospital only.
  • It is also admitted fact that within a few hours of admission in the CCL Hospital, the patient was shifted to BGH, where he died after ten days, i.e., 25.04.2008.
  • The main allegation made against the OP/Doctor says that the injection streptokinase was administered although the OP/Doctor was not qualified to do so and moreover, the injection was given when the BP of the patient was very high and the hospital was not equipped to deal with any emergency situation, following the injection
  • In this regard, the information given by Dr. Neeraj Prasad, Department of Cardiology, Abdur Razzaque Ansari Memorial Weavers Hospital, is quite material in which Dr. Prasad has stated that streptokinase injection can be given by all qualified MBBS doctors and also by trained paramedics.
  • It is clear, therefore, that the OP Doctor has not indulged in any negligence, just by giving the said injection.
  • Further, there is an affidavit on record given by four Doctors of the CCL Hospital, namely, Dr. S.C. Biswal, Dr. A.K. Dubey, Dr. Arvind Kumar and Dr. K.R.R. Singh which says that the OP/Doctor, Dr. Ramanand Jha consulted all of them and other doctors as per the system and practice in their hospital and it was professionally, unanimously decided to inject streptokinase for saving the life of the patient.  They have also given a certificate to this effect.  It has also been stated by these Doctors that all of them motivated the patient’s relatives to take the patient to BGH and only after that, the patient was shifted.
  • In the light of the above facts, it is clear that the State Commission has carried out a rational analysis of the facts and circumstances on record and came to the conclusion that the allegation of medical negligence against the OP/Doctor was not proved.  It is made out from the facts stated above that the decision to inject streptokinase was taken by a team of four doctors.  It is also clear that at the initial stage itself, the relatives of the patient were advised to take him to BGH, but they themselves decided not to do so.
  • From the above discussion, it is clear that there is no irregularity, illegality or jurisdictional error in the orders passed by the State Commission which may merit any interference at the revisional stage.  This petition is, therefore, ordered to be dismissed and the order passed by the State Commission is upheld.  There shall be no order as to costs.

Ref: National Consumer Disputes Redressal Commission: Revision Petition No. 4156 OF 2012: (From the order dated 08.08.12 in First Appeal No. 265/2009 & 358/2010 of Jharkhand State Consumer Disputes Redressal Commission): Parwati Devi vs Dr. Ramanand Jha: Hon’ble Dr. B.C. Gupta, Presiding Member; Pronounced On:  30th April 2014

medicolegal update
  1. Dear Dr K K, Giving 10% of your income or time was very important tenet of Sikhism. Most of the Sikhs donate this money to run langars or community kitchens or improving infrastructure of the Gurudwaras. It is followed by most of the Sikhs. Dr K S Chadha.

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