DMC/DC/F.14/Comp.758/2012/ 27 th April, 2012
The Delhi Medical Council through its Disciplinary Committee examined a complaint of Dr. Rekha Gupta r/o. C-6/281, Yamuna Vihar, Delhi–
110053(referred hereinafter as the complainant), alleging medical negligence on the part of Dr. Rakesh Gupta and Dr. Diwakar Jha, in the treatment administered to complainant’s father late Naranjan Lal Gupta
(referred hereinafter as the patient) at Saroj Hospital and Heart Institute,
Madhuban Chowk, Rohini Delhi – 110085 (referred hereinafter as the said
Hospital), resulting in his death on 5.5.2010
The Order of the Disciplinary Committee dated 21 st February, 2012 is reproduced hereinbelow :-
“The Disciplinary Committee perused the complaint, joint written statement of Dr. Rakesh
Gupta and Dr. Diwakar Jha, medical records of Saroj Hospital and Heart Institute and other documents on record.
The following were heard in person :
1) Dr. Rekha Gupta Complainant
2) Shri Rajesh Agarwal
3) ShriSanjeev Gupta
Husband of the complainant
Cousin of the complainant
4) Dr. DiwakarJha Consultant Physician, Saroj Hospital & Heart
Contd/:

5) Dr. Rakesh Gupta
(2)
Institute
Consultant Physician Cardiologist, Saroj
Hospital & Heart Institute
6) Dr. P.K. Bhardwaj Medical Superintendent, Saroj Hospital &
Heart
It is alleged by the complainant that the patient late Shri Niranjan Lal Gupta was admitted in
Saroj Hospital on 29 th
April, 2010 at 7.22 a.m. in a state of unconsciousness with a history of drug overdose/attempted suicide. At the time of admission, the patient was not responding to any stimuli and was in coma. The patient was suffering from depression and was on antidepressants. The patient allegedly consumed a lot of medicine either accidentally or with purpose to commit suicide. The patient was under care of Dr. Rakesh Gupta and Dr. Diwakar
Jha, both consultants at Saroj Hospital & Heart Institute. The patient was examined by Dr.
Diwakar Jha at 8.00 a.m. on 29 th
April, 2010 in ICU. She (the Complainant) informed Dr.
Diwakar Jha about possibility of drug overdose as a lot of medicines were missing from the patient’s almirah and a lot of empty strips were available. She showed them empty strips.
They were of lorazepam and imipramine. But they thought that the patient might have had stroke. The patient was also examined by Dr. Rakesh Gupta later on. Dr. Rakesh Gupta and
Dr. Diwakar Jha advised a lot of tests but did not perform gastric lavage. Neither sample of blood or urine was sent for toxicological analysis. Later she realized that this case was medical-legal in nature but no MLC was registered at the hospital. All the laboratory tests and ECG, MRI and CT Scan which were received in the evening of 29 th April, 2010(12 hours after admission) ruled out any organic lesion. Then these doctors started thinking of drug overdose. She was informed that the patient is in fourth stage of coma and would come out in seventy two hours. No specific treatment of drug overdose was started. No urine or blood samples were sent to identify correct poison. Only the patient was on conservative treatment.
The patient could not come out of coma in seventy two hours and started developing fever and
Contd/:

(3) chest complications and developed iatrogenic infection and started going down hill. While the patient was deteriorating, she talked to both these doctors; they turned abusive and asked the attendants to keep shut as they were doing their best. The patient was shifted on ventilator and later died on 5 th May, 2010 at 7.50 a.m. During the admission, both consultants kept her in dark about the treatment and prognosis of the patient. Both Dr. Diwakar Jha and Dr. Rakesh
Gupta talked rudely and behaved in most improper way. She talked to Medical Superintendent and complained about inadequate treatment being administered and abusive behaviour of doctors but Medical Superintendent did not do anything. She had to run around many times to get death summary which the hospital was not giving. Only when she threatened to go to court, the discharge summary was issued. She was of opinion that hospital and both these doctors have committed gross medical negligence. Basic duty to make a case of attempted suicide as medico-legal was not done even though the patient was unconsciousness and died later on without giving any statement. Basic duty to do gastric lavage and preserving it for toxicological analysis was not done. It ensured that some of the poison kept on entering the system which could have been taken out in time to save the patient. No blood or urine samples were sent for toxicological analysis so that correct poison could be indentified. Due to lack of correct nature of poison, correct treatment was not started leading to death. Only conservative treatment was done which is a gross negligence as effects of poison/s were not countered. The patient died due to lack of basic care and treatment at Saroj Hospital due to callous attitude of doctors and the hospital. She has requested Delhi Medical Council to take necessary disciplinary action against Dr. Diwakar Jha and Dr. Rakesh Gupta and declare their conduct as gross medical negligence.
Dr. Rakesh Gupta and Dr. Diwakar Jha in their joint written statement averred that that the patient was a known case of hypertension with depression and was brought to the casualty and then shifted to ICU in unconscious state on 29 th
April, 2010 early morning by attendants.
Accompanying persons gave history of depression and hypertension for which the patient was taking regular medications in the form of impiramine, lorazepam and clonazepam from
IHBAS. Attendants of the patient suspected excessive consumption (15-20) tablets of lorazepam. Pulse of the patient was normal, however, blood-pressure was 80/60 with bilateral
Contd/:

(4) small pupils reacting to light. Bilateral planters revealed no definite evidence of neurological deficit. Respiratory and cardiac evaluation was clinically normal. A tentative diagnosis of drug overdose/accidental in a case of depression was made and conservative management in the form of stomach wash, IV fluids injection lasix and injection mannitol was started.
Simultaneously, possibility of acute stroke was also kept (looking at his small pupils and low blood-pressure). The patient was simultaneously subjected to NCCT head followed by MRI and EEG. The results of these tests were normal. The patient showed some improvement in the form of level of consciousness by 30 th April, 2010 evening when the patient was drowsy but arousable; however, subsequently the patient developed fever and respiratory distress for which possibility of chest infection/pulmonary embolism/ARDS was thought and appropriate antibiotics were started alongwith mechanical ventilation and bronchoscopy. The patient succumbed to his illness on 5 th May, 2010 at 7.50 a.m. inspite of best possible resuscitative measures. Dr. P.K. Bhardwaj, Medical Superintendent, Saroj Hospital stated that as per hospital’s protocol the consultants do interact with the patient’s relatives during the morning and evening rounds and update them about the patient’s condition.
In view of the above, the Disciplinary Committee makes the following observations :
1.
The patient was a known case of hypertension with depression and was admitted at the said Hospital in unconscious state on 29 th
April, 2010. Accompanying persons gave a history of him being on lorazepam, clonazapam and imipramine from IHBAS and they had suspected excessive consumption of these tablets. Possibility of CVA?drug overdose?, was kept and the patient was treated accordingly; eventually the patient developed chest infection for which appropriate antibiotics alongwith mechanical ventilation were started. He succumbed to his illness on 5 th
May, 2010. The
Disciplinary Committee is of the opinion that the patient was treated as per standard protocol for his underlying condition.
2.
On being inquired as to why inspite of making a probable diagnosis of drug overdose,
M.LC. was not initiated in this case; Dr. Rakesh Gupta and Dr. Diwarkar Jha stated that as they did not suspect any foul play, they did not register MLC. They further
Contd/:

(5) stated that even though stomach wash done on 29 th
April, 2010, since no foul play was suspected, they did not send it for toxicological examination. The Disciplinary
Committee observes that in this case where a patient presented in an unconscious state with history of depression and drug overdose, MLC should have been initiated. The arguments of the doctors that since they did not suspect any foul play, hence, they did not register MLC is not legally tenable.
3.
The hospital authority of Saroj Hospital and Heart Insitute should evolve mechanism to improve communication between the treating doctor and the patient’s attendants.
In light of the observations made hereinabove, it is the decision of the Disciplinary Committee that no medical negligence can be attributed on the part of Dr. Rakesh Gupta and Dr. Diwakar
Jha of Saroj Hospital in the treatment administered to complainant’s father late Sh.
NiranjanLal Gupta at Saroj Hospital. The Disciplinary Committee, however, recommends that warning be issued to Dr. Rakesh Gupta (Delhi Medical Council Registration No. 2928) and
Dr. DiwakarJha (Delhi Medical Council Registration No. 19867) for the professional misconduct of not complying with the legal requirements of initiating the MLC in this case”.
Complaints stands disposed.
Sd/:
(Dr. O.P. Kalra)
Chairman
Sd/:
(Dr. Sunil Aggarwal)
Expert Member
Sd/:
(Dr. Prem Aggawal) (Dr. Vinod Khetarpal) (Ms. Avnish Ahlawat)
Member
Sd/:
Member
Sd/:
Member
The Order of the Disciplinary Committee in complaint No. 758 was confirmed by Delhi Medical Council in its meeting held on 11 th April, 2012 thorough a majority decision.
By the Order & in the name of
Delhi Medical Council
(Dr. GirishTyagi)
Secretary
Contd/:

(6)
Copy to :-
1) Dr. Rekha Gupta, r/o, C-6/281, Yamuna Vihar, Delhi-110053.
2) Dr. Rakesh Gupta, Through Medical Superintendent, Saroj Hospital &
Heart Institute, MadhubanChowk, Delhi.
3) Dr. Diwarkar Jha, Through Medical Superintendent, Saroj Hospital &
Heart Institute, Madhuban Chowk, Delhi.
4) Medical Superintendent, Saroj Hospital & Heart Institute, Madhuban
Chowk, Delhi.
5) Secretary, Medical Council of India, Phase-1, Pocket-14, Sector-8,
Dwarka, New Delhi-110077-for information & necessary action.
( Dr. GirishTyagi)
Secretary