JUDGMENT : Asper Smt . Neerja Singh,Presiding Member:- 1.This appeal arises from the order dated 24-11 -06, passed by District ConsumerDispute Redressal Forum, Vidisha directing the opposite party Doctor B.P. Khare to pay Rs . 25,000/- as compensation and Rs .500/- as cost, on the ground of negligence allegedly committed by him in thetreatment of the complainant's son. 2.The facts in brief are that the respondent-complainant's minor son,(hereinafter referred to as 'the patient'), was suffering from fever on 19-1-03 . He consulted Dr. B.P. Khare , who advised a blood test. He also prescribed somemedicines and injection Lariago for Malaria. When hewent back with the blood report, the doctor prescribed some more medicine andgave antibiotic injections. The same night he advised 3 tablets of Primaprin 15 mg. He did not warn of any side-effects, nordid he advise a test G6PD, which was necessary. In spite of the medicines,there was deterioration in the patient's condition. He was also having problemsin passing urine. However, the respondent doctor kept reassuring them that thepatient would become all right. On 21-3-03 ,he went to the doctor and asked him to come and examine the patient. He refusedto do so, but wrote some more medicines on the same prescription. As thepatient's condition kept worsening, he was taken to Bhopal and admitted at Akshay Heart Hospital ,where he was given blood transfusions and treatment. He remained there till 30-1-03 . The respondent-complainantalleged that the respondent-Doctor gave 45 mg Primaprin without any knowledge of the drug and without any test for G6PD deficiency. 3.The appellant-Doctor states that when the patient was brought to him heprescribed Metopar , for lowering fever andcontrolling vomiting. After Pathological Test, when it was found that he wassuffering from Malaria Falciparum , other medicineswere prescribed. The antibiotic Widesef was given inthe prescribed dose. The medication Primaprin (generic name Primaquine ) is given to those who testpositive for Malaria Falciparum . He further statesthat G6PD test is not mandatory before prescribing Primaquine .He also avers that Primaquine is one of the safestanti-malarial drug , which has the least side-effects.The patient did not consult him after 21-1-03 . He denies refusing toexamine the patient or that he ever prescribed any medicines without seeing thepatient. 4.The Forum below held the appellant-Doctor negligent on the ground of notconducting the G6PD test, even after the patient complained of passing redurine. He denies refusing toexamine the patient or that he ever prescribed any medicines without seeing thepatient. 4.The Forum below held the appellant-Doctor negligent on the ground of notconducting the G6PD test, even after the patient complained of passing redurine. 5.We have heard the respective contentions of the learned Counsels of the partieson the merits of the case and perused the documents on record. 6.The main allegation of the respondent-complainant is that Primaquine was given without a G6PD test, and in the wrong dosage. Secondly, he allegesthat the appellant did not come to see the patient. 7.To get a clearer picture of the G6PD deficiency, we went through medical textsand websites, giving information of this deficiency, on the Internet. Medicalliterature gives the information that G6PD deficiency is the lack of Glucose-6-Phosphate Dehydrogenase (an enzyme present in redblood cells) in the blood, which can cause a type of anaemia known as haemolytic anaemia .G6PD deficiency is inherited people are born with the deficiency. Unless thepatient himself informs the physician, there is no reason for the doctor tosuspect that he has this genetic deficiency. 8.All the websites giving information regarding this deficiency were unanimous inwarning that all anti- malarials can be harmful inpeople with G6PD deficiency. They have specified the anti- malarials - - Primaquine - Pamaquine - Chloroquine -Quinine (a) en . wikipedia . org/wiki/Glucose-6-phosphate_dehydrogenase _ deficiency (b) www.gdpd . org/ favism/english/index.mv (c) www.healthsyslem.virginia.edu/uvahealth/adult _blood/ glucose.cfm 9.Other websites like www.drugs.com/cons/Chloroquine.html andwww.malaria-ipca.com/chloroquine.html also state that Lariago , Melubrin , Nivaquin -P, Resochin (general name Chloroquine )may cause serious side-effects, affecting the blood, in patients with G6PDdeficiency. 10.We thus come to the conclusion that G6PD deficiency, is genetically inherited,and that all anti- malarials can cause serious sideeffects, like haemolytic anaemia ,in persons with this deficiency. It is undisputed that the patient wassuffering from Malaria Falciparum , as is evidenced bythe blood test report of 19-12-03 .One of the treatment for this decease is Primaquine . The appellant has filed the National DrugPolicy on Malaria (2007) issued by the Ministry of Health and Family Welfarewherein Primaquine is advised for patients sufferingfrom P.Falciparum . 11.Information available on the Internet also supports the use of Primaquine for Malaria Falciparum : " Primaquine is hence a must for both P.vivax and P.Falciparum infections. At present, Primaquine is the only drug available for tissue schizonticidal activity in P.vivax Malaria and Gametocytocidal activity in P. Falciparum infection. 11.Information available on the Internet also supports the use of Primaquine for Malaria Falciparum : " Primaquine is hence a must for both P.vivax and P.Falciparum infections. At present, Primaquine is the only drug available for tissue schizonticidal activity in P.vivax Malaria and Gametocytocidal activity in P. Falciparum infection. Therefore, it must be used in boththese infections. Therefore, at present there are no alternatives to Primaquine . Newer anti- malarials like Mefloquine or artemisinin derivatives are NOT substitutes for Primaquine ." 12.The appellant-Doctor gave medication for the treatment of Malaria, but therespondent alleges that no test for G6PD was advised by the appellant-Doctor.The respondent-complainant has relied upon the medical text, Harrisons Principles of Internal Medicine, 14th Ed. Vol. 1Pg. 1188, which states that Primaquine should begiven after laboratory tests for G6PD deficiency have proved negative. 13.However, the appellant has filed the National Drug Policy on Malaria (2007),issued by the Ministry of Health and Family Welfare and the Training Module forMedical Officers of Primary Health Centres of theState Malaria Control Society, Madhya Pradesh. Though these documents advisethe use of Primaquine for Malaria Falciparum ,there is no warning or rider to conduct a G6PD test before prescribing themedicine. It thus follows that in actual practise , in India whereMalaria is extensively prevalent, the drug isprescribed without any test. This is the standard practise followed in this country, and the appellant doctor acted in accordance withthis. 14.Further, if the argument of the respondent is to be accepted, then it will meanthat before prescribing any anti-malarial, the G6PD test should first be done,since all anti- malarials can cause serious sideeffects. We do not feel inclined to accept this contention. If medicalpractitioners in our country were to advise the G6PD test before givingtreatment of Malaria, it would be practically not possible to treat this widespreaddisease. Most places in the country do not even have facilities to conduct thistest, including Ganj Basoda ,where the patient was treated. 15.The Hon'ble Supreme Court in the case of JacobMathew, 2005(5) M.P.H.T. 462 (SC) = (2005) 6 SCC 1 , held that the inadequaciesof the system and the specific circumstances of the case have to be consideredbefore a doctor can be held negligent. "One may have notions of best orideal practice which are different from the reality of how medical practice iscarried on or how the doctor functions in real life". "One may have notions of best orideal practice which are different from the reality of how medical practice iscarried on or how the doctor functions in real life". 16.As regards prescribing the wrong dosage, 45 mg of the drug was given, which isalso prescribed in the pamphlet of the Directorate of Health Services. Thecomplications suffered by the patient were not due to wrong dosage, but due tothe G6PD deficiency, which caused haemolytic anaemia and jaundice, on consuming the anti- malarials . 17.It is true that the appellant doctor did not detect the true condition of thedisease. However, as the literature filed by the appellant shows, Malaria Falciparum can have direct complications like anaemia , cerebral malaria, acute renal failure and haemolytic jaundice-liver damage. It was easy to mistakethe patient's complaints, taking them to be related to the disease and not dueto G6PD deficiency. It is now too well settled that a doctor can only beliable, 'if his diagnosis is so palpably wrong as to prove negligence, that isto say, if his mistake is of such a nature as to imply absence of reasonableskill and care on his part, regard being had to the ordinary level of skill inthe practitioner'. 18.Finally, we also find no merit in the respondent's contention that the doctordid not see the patient despite repeated requests and prescribed medicineswithout examination. There is no substance in the allegation against thedoctor. Even otherwise, if the doctor was unable to come, the patient couldhave been taken to his clinic. 19.In view of the aforesaid discussion, this appeal is allowed and the impugnedorder of the Forum below is set aside. No order as to costs.