Abdul Jabbar had filed a complaint against a Malappuram-based doctor this year after his 5-year-old son lost his eyesight in 2017 due to reaction to a drug prescribed by the doctor.

Kerala boy loses vision due to medicines Therapeutic misadventure or unforeseeable reaction
news Health Wednesday, December 19, 2018 - 15:04

On November 11, a Malappuram-based man was allegedly attacked with chilli powder and beaten up. According to Abdul Jabbar, a 32-year-old daily wage worker from Ponnani taluk, the attack was to warn him to take back a complaint he filed against a local doctor, who prescribed drugs to his 4-year-old son. The drugs, Jabbar alleges, triggered an allergic reaction that cost his son Abdul Rahiman his sight in 2017.

After going through multiple treatments and surgeries to restore his son’s eyesight, for more than a year, Abdul approached the local Child Welfare Committee. On November 4 this year, he filed a complaint with CWC against NM Salim, a paediatrician working in the government hospital in Ponnani, accusing him of medical malpractice.

The Malappuram Child Welfare Commission co-ordinator Manikandan, however, told TNM that the CWC had referred the case to the Ponnani police to investigate.

“We are not sure whether this is medical negligence or not. The boy and his parents approached us and said it was a skin allergy caused due to drugs. Since this is not the typical care and protection case and one related to medical negligence, we have asked the local police to take statements and investigate the matter,” district co-ordinator Manikandan told TNM.

A few days after this, on November 11, Abdul says, he was beaten up by two bike-borne men, who wore helmets, demanding that he revoke the complaint against the doctor.

Following the attack, Abdul Jabbar was admitted to a local hospital in Ponnani last month. He later filed a second complaint with the local police, against the attack on him by the unidentified men.

When TNM contacted the doctor, NM Salim, he said, “I prescribed standard drugs to the child after I suspected symptoms for chicken pox - Calamine lotion and azythromycin. Three days later, they came to me as the boy’s condition worsened. I suspected Steven Johnson’s and immediately referred them to the medical college hospital where they confirmed it. Medically, they can’t point fingers at me because this is an unforeseeable situation. They tried to threaten me and have been demanding money. As far as the chilli powder attack is concerned, I am surprised that they are accusing me. Why would I do something like that when I know I’m not wrong. I have also complained to the police demanding a probe.”

How it all started

In February 2017, Jabbar and his wife had consulted NM Salim as their son Abdul Rahiman had developed a fever.

"My son, who was 4.5 years old at the time, was running a mild fever and we had decided to take him to the doctor. The doctor diagnosed that he had chickenpox and prescribed antibiotics for five days,” Abdul Jabbar recounts.

After two days of taking the prescribed drugs, the boy developed a severe allergic skin reaction with lesions breaking out all over his body. The allergy even affected his eyes, leading to severe visual impairment.

Following the allergic reaction, the parents rushed him to the Government Medical College Hospital in Thrissur, where the doctors identified that the 4-year-old suffered from Steven Johnson's syndrome - a rare but serious medical disorder that affects the skin, mucous membrane, genitals and eyes.

The hospital referred them to the SAT Hospital, a government medical college in Thiruvananthapuram, for further treatment in March 2017.

In their out-patient medical record, the paediatric ward of the SAT government hospital confirmed that the allergic reaction was a result of “Steven Johnson's Syndrome and Toxic Epidermal Necrolysis (a potentially life-threatening dermatological disorder) overlap” with the boy reportedly being “allergic to Paracetamol, Azithromycin and acyclovir” - anti-biotic drugs used to treat fever, bacterial and viral infections.

The boy was later referred to the Regional Institute of Ophthalmology in Thiruvananthapuram, to undergo ocular surface reconstruction - a surgery to restore the epithelium (the thin outer layer of tissue on the body surface) cornea in both eyes, as he lost his eyesight due to the allergic reaction.

“The child may be taken for emergency ocular surface reconstruction at high risk. Can be given antibiotics - Ciplox, Azenam and Steroids (which can potentially trigger another allergic response) SOS after getting high-risk consent,” the casualty outpatient record from SAT Medical College in Thiruvananthapuram read.

After consulting with specialists, Abdul Rahiman underwent a highly risky reconstruction surgery in March 2017, for which, his father donated a part of his cornea epithelium to him.

“I could not see anything in one eye after they scraped the surface of my eyes for my son’s surgery. They said it will regrow,” Abdul Jabbar tells TNM.

The family is currently consulting at Sankara Netralaya in Coimbatore. Abdul Rahiman has undergone a few more eye surgeries and the eyesight is slowly being restored, says his father.

“However, after I donated a part of my cornea tissue to my son, I have not been able to go for daily wage labour due to the dusty environment. It was affecting my eye-sight, so I looked for jobs in restaurants. It was at this time that I was attacked with chilli powder in my eyes,” he adds.

Medical malpractice or unforeseeable reaction?

This case has sparked a debate on whether Abdul Rahiman lost his eyesight as a result of medical malpractice or was it an unforeseeable reaction.

However, experts in the field are clear that there is no culpability as the allergic reaction was unforeseeable.

“If the accused doctor's chicken pox diagnosis was accurate and had prescribed the right amount of dosage to the child, and if the child developed the reaction after this, the doctor cannot be blamed. Steven Johnson's is a rare disease and any drug can potentially trigger it, even paracetamol. There are no available tests in the country to diagnose the syndrome. It cannot be predicted,” Dr Rakesh, a Chennai-based paediatrician, tells TNM.

Dr Arun Kumar, a Pune-based anaesthetist said, “SJS is rare and unpredictable. One cannot know who will get it. Besides, it is difficult to treat. In my opinion, there is no malpractice here per se. You cannot claim negligence cause there is no reasonable precaution the doctor could have taken to prevent it.”

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