Gyan Mishra was admitted to Sahara Hospital in Lucknow, where he underwent various tests. His serum creatinine level was found to be extremely high at 3.43. However, he was neither advised to undergo further investigations, nor to consult a nephrologist. It was only on December 9, 2013, when he was hospitalised again, and seen by neurologist Sandeep Agarwal and by nephrologist Muffazal Ahmed, it was found that Mishra was suffering from end-stage renal disease and required dialysis.
He was administered iron injections during hospitalisation. Subsequently, he was prescribed Encicarb iron injections on March 18, 2014, and again on June 26, 2014, without checking his ferritin level. He was also administered Liofen and Metformin. Later, Mishra learnt he had been given injections and medications without reviewing his ferritin level or evaluating his cardiovascular condition. He filed a complaint before the National Commission against Sahara Hospital and its doctors.
The latter contested the case. They alleged Mishra was a chronic alcoholic with a long history of diabetes, and was also suffering from kidney disease with urosepsis and chronic liver disease. They argued that about 40 per cent of patients with diabetes develop nephropathy leading to renal failure. They claimed that erythropoietin replacement is a costly therapy, so a trial of intravenous iron was given for anaemic chronic kidney disease. These iron injections and tablets were administered after subjecting Mishra to a complete iron profile which detected him to be anaemic. While the ferritin level was checked initially, they claimed there was no need to check it every time.
The Commission observed that administering injectable or oral iron should be generally avoided, according to the Indian Society of Nephrology’s guidelines. If it has to be administered in exceptional circumstances, then the ferritin level has to be closely monitored. The Commission found that Encicarb iron injection was administered more than three months after the last ferritin level test, with the result that Mishra's system became overloaded with iron, as detected during an endoscopy at Fortis Hospital. So, the Commission concluded that Sahara Hospital and its doctors had been negligent in administering iron.
The Commission also found that Mishra had been administered a medicine called Liofen, which medical literature states that when given to patients with renal impairment, it results in toxicity regardless of the dosage. The Commission held this to be negligence.
The doctors argued that they had been exonerated by the Ethics Committee of Uttar Pradesh Medical Council, so they could not be held liable. The Commission rejected these arguments. Accordingly, by its order of November 7, 2019, delivered by Justice V.K. Jain, the National Commission awarded Rs 30 lakh towards compensation, out of which Rs 20 lakh would be paid by Sandeep Agarwal and Rs 10 lakh by Muffazal Ahmed. Sahara Hospital was held vicariously liable to pay the entire compensation on behalf of both the doctors. Also, Rs 25,000 was awarded as costs.
The writer is a consumer activist\