eMedinewS
5th October 2014, Sunday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and DST National Science Communication Awardee

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

Human Stampede (What causes it and how to prevent it)

32 people killed in stampede in Patna's Gandhi Maidan during Dussehra event

  • Human stampedes most often occur during religious pilgrimages and professional sporting and music events, as these events tend to involve a large number of people. They also occur in times of panic (e.g. as a result of a fire or explosion) as people try to get away.
  • When the crowd tries to get/move towards something, because the crowd is so big, those in the back continue pushing forward not knowing that people in the front are being crushed.
  • Deaths from human stampedes occur primarily from compressive asphyxiation or traumatic asphyxia and not trampling. This is referred to as crowd crush. The compressive force occurs from both horizontal pushing and vertical stacking.
  • Traumatic asphyxia is a rare syndrome first described over 150 years ago by Olivier. It is caused by sudden compressive chest trauma and is associated with craniocervical cyanosis, facial edema and petechiae, subconjunctival hemorrhage and neurological symptoms.
  • Presently, traumatic asphyxia is described as asphyxia occurring as a result of sudden or severe compression of the thorax or upper abdomen. It is most often associated with blunt trauma secondary to a crushing injury mechanism. People who succumb in these scenarios typically die in a vertical position (standing up).
  • When force is applied front to back or vice versa, chest expansion is compromised. When force is applied side to side, chest expansion is not compromised. Survivors of such incidents have described this positional dyspnea. This same compression prevents a fall to the floor. Victims do not collapse to the floor until after the crowd density and pressure have been relieved.
  • The most widely accepted explanation is that the crushing injury puts pressure on the mediastinum and the heart. This pressure forces blood out of the right atrium in a retrograde fashion into the valveless innominate and jugular veins. This results in a sudden and rapid increase in the pressure of the small venules and capillaries of the face and head, resulting in petechial hemorrhages. Furthermore, these damaged small vessels become atonic, causing stasis and pooling, which leads to cyanosis. A critical step in this process is a sudden inspiration and the closure of the glottis. This is believed to be secondary to a fear response and is crucial in order to elevate the intrathoracic pressures to a level that will cause damage.
  • Some people who die of traumatic chest compression may not have petechiae. This may be seen with chest compression that is great enough to impair the left heart function as well as the right. Increased cephalic venous pressure will not develop in this scenario because even though the venous return is impaired, the input arterial pressure is also compromised.
  • The development of sequelae depends on the duration of the crush injury. Prolonged compression is associated with increased mortality and is most likely secondary to apnea and hypoxemia.
  • Warning signs of a crowd crush include density of more than four people per square meter, at which each person is being touched on four sides. A loose crowd is 10 square feet (one square meter) per person. The critical density is 10 people per square meter, at which point individuals are pushed together shoulder-to-shoulder and front-to-back. 
  • Once you’re surrounded by the remorseless pressure of hundreds of other bodies, you may be physically incapable of any action at all. A crowd that’s only 6 or 7 people deep can exert 1000 pounds of pressure, enough to topple brick walls and bend metal stanchions.
  • People have some chances of survival only if they are turned sideways to the press of the crowd, so that their shoulders absorb the force rather than their ribcage, and they are still able to breathe
  • To avoid or escape from a crowd crush, one is advised to move sideways, particularly between swells.
  • Public entertainment venues to be equipped with doors that open outwards. 

News Around The Globe

  • Seven cases of successful treatment of acute migraine symptoms using beta blocker eye drops have been reported in Missouri Medicine 2014;111(4):283-8. The literature on beta-blockers for acute migraine is reviewed. Oral beta blocker medication is not effective for acute migraine treatment. This is likely due to a relatively slow rate of achieving therapeutic plasma levels when taken orally. Topical beta blocker eye drops achieve therapeutic plasma levels within minutes of ocular administration which may explain their apparent effectiveness in relief of acute migraine symptoms.
  • Four substances have been added in the U.S. Department of Health and Human Services 13th Report on Carcinogens, a science-based document that identifies chemical, biological, and physical agents that are considered cancer hazards for people living in the United States. The new report includes 243 listings. Ortho-toluidine, used to make rubber chemicals, pesticides, and dyes, has been reevaluated and is now listed as a known human carcinogen. Three substances have been added as reasonably anticipated to be human carcinogens. These include 1-bromopropane, used as a cleaning solvent and spray adhesive; cumene, used to make phenol and acetone, and also found in fuel products and tobacco smoke; and the wood preservative mixture pentachlorophenol.
  • Low levels of vitamin D are unlikely to cause type 2 diabetes, new research suggests. The findings were published online October 1 in Lancet Diabetes & Endocrinology by Zheng Ye, PhD, of the MRC Epidemiologic Unit, University of Cambridge School of Medicine, United Kingdom, and colleagues.
  • British scientists have identified a sequence of biological events that could trigger life-threatening asthma attacks in people suffering from colds. Researchers noted that the cytokine interleukin-25 (IL-25) may play a pivotal role in the effect that viruses causing colds have on people with asthma. The study is published online October 1 in the journal Science Translational Medicine.
  • Levothyroxine as monotherapy should remain the standard of care for the treatment of hypothyroidism, despite the common combination of the drug with alternative agents, according to new treatment guidelines by the American Thyroid Association (ATA). The guidelines were published online September 29 in Thyroid.

National News

Congratulations to Prof. Alka Kriplani, Prof. and Head, Deptt. Of Obst and Gynae, AIIMS, New Delhi?

today emedipicsElected president FOGSI (Federation of Obstetric and Gynaecological Societies of India) for the year 2016. It is the biggestandmost active association in the world with 30000 Gynaecologist form all over India as its members and 215 Gynae societies affiliated to it


Dr KK Spiritual Blog

Why do we not touch papers, books and people with our feet?

In every traditional Gurukul, no studies start without chanting the following

“Saraswati namasthubhyam
Varade kaama roopini
Vidyaarambham karishyaami
Sidhirbhavatu me sadaa”

O Goddess Saraswati, the giver of Boons and fulfiller of wishes, I prostrate to You before starting my studies. May you always fulfill me…

Indian Vedas consider knowledge about self as the supreme knowledge and all tools for the same are considered sacred and divine and must be given respect. The traditional custom is not to step on any sacred educational tool.

Inspirational Story

Nothing Is More Important

I sat next to the bed of old man, a friend for over twenty years, and held his hand. Hal was dying. We both knew these next few days would be his last.

We spent time reminiscing about his long and fruitful career as a church pastor. We talked about old friends. We chatted about his family. And I listened as he offered sage wisdom and advice to a member of a "younger generation."

At a lull in the conversation, Hal seemed to carefully consider what he was about to say next. Then he squeezed my hand, gazed intently into my eyes and whispered, just loud enough for me to hear, "Nothing is more important than relationships."

I knew that this was somehow near the pinnacle of his life's learning’s. As he considered all of his experiences -- personal, professional, spiritual and family, this one ultimate observation surfaced above the rest: "Nothing is more important than relationships."

"Don't get overly caught up in your career," he seemed to be saying to me. "Likewise, don't use people in order to achieve your goals, and then throw them away. No project, no program, no task should be pursued at the expense of friends and family. Remember," I heard him saying, as clearly as if he were speaking the words, "that in the end, only your relationships will truly matter. Tend them well."

Writer Og Mandino puts it this way: "Beginning today," he said, "treat everyone you meet as if he or she were going to be dead by midnight. Extend to them all the care, kindness, and understanding you can muster, and do so with no thought of any reward. Your life will never be the same again."

At the end of a long life, my friend Hal would have agreed.

Rabies News (Dr A K Gupta)

A previously immunized person is bitten again. What is the re-exposure immunization schedule?

Only two doses of vaccine at Days 0 and 3 are required. RIG is not required (WHO 2007). However, in laboratory-confirmed rabies exposures, a full course of PEP and RIGs is recommended irrespective of past rabies immunization. In rabies, it is safer to overtreat than undertreat.

Cardiology eMedinewS

  • There are more signs that beta-blockers are of no use—and may potentially be harmful—in patients with stable coronary artery disease (CAD) or with CAD risk factors only, this time from a post hoc analysis of the CHARISMA trial. The new analysis published online September 30, 2014 in Circulation: Cardiovascular Quality and Outcomes, adds to a growing body of evidence that is chipping away at the patient group in whom beta-blockers are clearly beneficial.
  • Patients undergoing coronary artery bypass grafting (CABG) surgery may not have to follow a strict blood sugar management strategy after surgery, according to a study published in the October 2014 issue of the Annals of Thoracic Surgery.

Pediatrics eMedinewS

  • Family-based therapy (FBT) may be the best, and most cost-effective, treatment for teens struggling with anorexia nervosa (AN), reveals a new study published online in JAMA Psychiatry.
  • Timing of gluten exposure and duration of breast-feeding do not appear to affect the development of celiac disease in high-risk children, suggest two new randomized controlled trials published in the October 2 issue of the New England Journal of Medicine.

Quote of the Day

The future has many names: For the weak, it means the unattainable. For the fearful, it means the unknown. For the courageous, it means opportunity. Victor Hugo

IMA NEWS

  • Indian Medical Association Delhi North Zone organized a Dharna on 2nd Oct ,the National Anti Quackery Day at the heart of North Delhi---Deep Market ,Ashok Vihar which is a busy bustling& marketplace. The dharna was in protest against the continued presence of more than 40000 Quacks in Delhi which is vying for a worldclass status. The recent Governmental talk of regularizing QUACKS ,was a last nail in the coffin. President IMA-DNZ Dr.M.K.Grover deplored the Health situation in Delhi whereby many of its inhabitants are unknowingly and inadvertently becoming the victims of Quacks.
  • September 28 will be observed as the Rational Antibiotic Day and the week thereafter, has been declared as Antibiotic Awareness Week. September 28 has been selected in commemoration with Sir Alexander Fleming’s discovery of penicillin.
  • Plans on to put nation’s health in hands of quacks: The move by ministry of health and family welfare to ‘accommodate and rehabilitate’ quacks to compensate for the scarcity of qualified medical practitioners has rattled the medical fraternity. The ministry has called a meeting of the health secretaries of states to discuss the issue and accordingly modify laws. At a media interaction recently, health minister Harsh Vardhan too had indicated that such a move was under consideration. ‘In the present condition when doctors refuse to accept rural postings, the health care system in rural areas is very much dependent on quacks. So we have to chalk out a strategy to use the services of quacks in those remote areas. Though, the final decision on this issue will be taken only after meeting with state secretaries on 9 October,’ Vardhan had said at a recent media interaction. [Millennium Post]
  • On the shortage of doctors, Goyal said, ‘There is no shortage of medical practitioners in the country as such. The ministry must make use of the services of about 30,000 fresh medical graduates every year by deputing them in rural areas for at least six months. Doctors are ready to work in remote areas, provided there are some basic facilities available.’
  • There is a scarcity of about 6 lakh doctors as the present strength of medical practitioners is just 8.5 lakh. According to WHO recommendations, there should be one doctor for every 1,000 people, but in actual there is only one doctor for 2,000 people.
  • According to Indian Medical Association data, it is estimated that about 10 lakh quacks are practicing allopathic medicine. 
  • Doctors appear to be in no mood to give any concession in the consultation fee to the below poverty line (BPL) patients as was announced by the Bihar chapter of Indian Medical Association (IMA) and Bihar Health Services Association (BHSA) on September 26. Sensing the belligerent mood of its members, the umbrella bodies (IMA and BHSA) appear to have mellowed down and their office-bearers are speaking in a different language than the one they had spoke on September 26, while holding a meeting with RJD Madhepura MP Rajesh Ranjan alias Pappu Yadav. Pappu Yadav had launched a campaign in the Kosi region demanding reduction in consultation fee of doctors. On Monday, BHSA general secretary Ajay Kumar said: “A wrong impression has been given that the doctors have decided to accept Pappu’s diktat. Certainly, the MP cannot force the doctors on the stipulated amount of fee he or she should charge from the patients. Again, Pappu’s prescription which says that an MBBS doctor shall charge Rs 100-150, an MD Rs 200-225 and an experienced doctor Rs 300, may go against the people as many doctors in the state are charging even less fee then what the MP has suggested.” (The telegraph)

Wellness Blog

American College of Sports Medicine

  • Healthy adults should do flexibility exercises (stretches, yoga, or tai chi) for all major muscle-tendon groups – neck, shoulders, chest, trunk, lower back, hips, legs, and ankles– at least two to three times a week.
  • For optimal results, you should spend a total of 60 seconds on each stretching exercise. So, if you can hold a particular stretch for 15 seconds, repeating it three more times would be ideal. If you can hold the stretch for 20 seconds, two more repetitions would do the trick.

ePress Release

Travel more than doubles risk of blood clots

New Delhi: Long distance travelers should periodically move around and stretch their legs instead of just sitting and also drink plenty of water to stay hydrated, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Sr National Vice President Indian Medical Association.

Long–distance travel can lead to potentially fatal blood clots in some people and the risk grows with the length of the trip. Those at increased risk of blood clots include cancer patients, people who have recently had major surgery such as a joint replacement, and women on birth control pills.

In general, travel is associated with a nearly three-fold increase in the risk of venous thromboembolism (blood clots that form in the veins), often in the legs. If such a clot dislodges and travels to the lungs, it can cause a potentially fatal condition called pulmonary embolism.

A combination of factors including dehydration and hours of sitting in cramped conditions explains why some people develop blood clots.

A review, published in the Annals of Internal Medicine, analyzed 14 studies involving more than 4,000 cases of venous thromboembolism and found that travelers had a nearly three–fold higher risk of blood clots than non–travelers. The risk climbed along with the duration of the trip, rising 18 percent for every two hours of any type of travel, and by 26 percent for every two hours of air travel.

But there is no reason for panic, because the absolute risk to any one traveler is still low. People who travel long distances should be aware of the risk of blood clots and learn to recognize the symptoms. Symptoms of a blood clot in the leg include pain, warmth, swelling and redness in the limb. If the clot travels to the lungs, it may cause sudden shortness of breath, chest pain or a cough that produces blood.

eMedi Quiz

A 64-year-old old hypertensive obese female was undergoing surgery for fracture femur under general anesthesia. Intra operatively her end-tidal carbon-dioxide decreased to 20 from 40mm of Hg. followed by hypotension and oxygen saturation of 85%. What could be the most probable cause?

1. Fat embolism.
2. Hypovolemia.
3. Bronchospasm.
4. Myocardial infarction.

Yesterday’s Mind Teaser: A lesion of ventrolateral part of spinal cord will lead to loss (below the level of lesion) of:

1. Pain sensation on the ipsilateral side.
2. Proprioception on the contralateral side.
3. Pain sensation on the contralateral side.
4. Proprioception on the ipsilateral side.

Answer for yesterday’s Mind Teaser:3.Pain sensation on the contralateral side.

Correct answers received from: Dr Poonam chablani, Daivadheenam Jella, Dr.Bitaan Sen & Dr Jayashree Sen, Dr palanivelrajan

Answer for 2nd Oct Mind Teaser: b. Auspitz sign

Correct answers received from: Dr Jainendra Upadhyay, Dr Avtar Krishan, Dr B K Agarwal, Dr Ayyavoo Erode, Dr Bitaan Sen, Dr Jayashree Sen, Dr Prakash Khalap.

Send your answer to email

 

emedipicstoday emedipics

Health Check Up and CPR 10 Camp at SGSS Vidyalaya, Chirag Delhi on 22nd September 2014

mela_brochure
Self-Assessment-Quiz

 

expert_choice
Zee News – Health Wealth Shows

Alcohol

press release

Exercise impact on the knee

video of day video of day

Other Blogs

Video Library

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

cpr 10 mantra
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 female with past history of DVT needed an oral contraceptive prescription.
Dr. Bad: Start OC patch (transdermal).
Dr. Good: You cannot be on OC.
Lesson: There is a possibility of an increased risk of venous thromboembolism in oral contraceptive patch users.

 

Make Sure

Situation: A diabetic patient died of flu pneumonia.
Reaction:Oh my God! Why was flu vaccine not given?
Lesson: Make sure tthat all diabetics are given flu vaccine every year.

eMedinewS Humor


I remember one time I told my doctor I had a ringing in my ears.
His advice: "Don’t answer it."

Twitter of the Day

Dr KK Aggarwal: Shorter acting calcium channel blockers linked to breast cancer


Dr Deepak Chopra: True ambulance, or affluence, is the ability to fulfill one’s desires with minimal effort

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 Sir, emedinews is very informative newspaper. Regards: Dr Kalpana

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