The facts of the case were:
The patient was admitted to Artemis hospital with complain of severe headache for the past 10 days. The treating doctor Dr. RK Mani advised to get the Lumbar puncture done and recommended Dr. Jyoti Goyal who is a consultant in the Internal medicine and ICU to perform the procedure.
Friday 10th April: Anisha Jain was admitted to Artemis Hospital under Dr. Jyoti Goyal and Lumbar puncture was done around 1 pm. The CSF examination report was told to us in the evening that there are some issues they suspect in the report and further lab tests of CSF needs to be done
Saturday, 11th April: In the morning at around 6am, a resident doctor came and told us that she has been diagnosed with a confirm case of Crytococcal Meningitis. She advised that there are 2 types of medicines available for treating this
a) Conventional formulation which costs around 250 for a daily dose. It is nephrotoxic but much more effective. Since she has a healthy kidney function and in young, we would prefer to use this medicine and keep her under observation
b) Foreign formulation: Daily dose costs around 25,000 and this is a relatively safe medicine but with lower efficacy
Dr. Jyoti said she has discussed the same with Dr. Mani and they both would advise to go with Amphotret (conventional medicine). We gave our consent to start the medication.
The prescription said that Amphotret 25mg to be given under constant monitoring. In addition, Flucytosine 5gm in 4 divided doses. Attached is the snapshot of the register maintained with the nurses
Sunday, 12th April: We were told that Amphotret 25 will again be given today also and then we will jack up the dose to the full 50mg/day
On Sunday afternoon, I went to the billing to check the details. When I went through the bills, I was shocked to note that they have billed for Ambisome 50mg vial @ 4,500/- on Saturday. Again for Sunday, Ambisome was billed. I checked with the nurses as to what has been given and if there is a mistake. Nurses confirmed that they are indeed giving 25mg of Ambisome per day. I immediately called up the Dr Jyoti to find out what the confusion between Ambisome and Amphotret is and why Ambisome is given. She replied that she has prescribed Amphotret 25mg only and will check with the nurses.
Monday 13th April: Morning when I again checked with the Dr. she said we will today start with Amphotret 25 mg as Ambisome was wrongly given.
Tuesday, 14th April: Dr Jyoti said that lets is increase the dose of Amphotret directly to 50 mg as the patient condition is not improving and we cannot take a risk by increasing slowly to 35mg and then to 50mg
The patient showed signs of improvement on Saturday after 5 days of administering 50mg of Amphotret along with Flucytosine 5gm.
The case is that the hospitals and Dr. in a clear show of negligence, lack of service and patient care, without due care gave the medicine having the same salt name – Amphotericin B however the preparation was completely different between Amphotericin B Deoxycolate (AmBD) and Lipsomal Amphoterin B (LAmB)
The patient suffered for 2 days in excruciating headache while the doctors and hospital casually went about doing their business. I highlighted the issue to the hospital and they denied taking any responsibility for the same or explaining the exact chain of events that led to this mix up. The hospital and Dr. Jyoti should have acted responsibly in giving the medicine when the standards to deal with Amphotericin and its combination are clearly listed (see attached IDSA guidelines on caution while dealing with Amphotericin).
1. IDSA guidelines on Cryptococcal Meningitis
2. Snapshot of Dr. Prescription clearly showing that Amphotret is given on 10th and 11th April when it was not
3. Scanned copy of original bill paid which shows Ambisome is is given to the patient and Amphotret was started only from 12th April