Q: My friend is suffering from Hepatitis B, schizophrenia and diabetes. He was admitted to a psychiatric unit. I don't have the exactly details, God knows what they treated him with, but they say that his ammonia levels go high when they administer the drugs for schizophrenia. They said that he is all right, but all of a sudden they called his family and told them to take him to Mumbai to show to a hepatologist. He is currently in Mumbai, in the ICU but under stable conditions. We feel cheated, because when he was taken there, he was physically fit with no symptoms of hepatitis B infection. Now his speech is impaired, he keeps on mumbling things all the time. We feel this is a case of medical negligence, could you please help me out if I were to provide the case history. If this is a case of medical negligence, whom can we approach to get justice?

A:Your friend has an unfortunate combination of diseases. These involve his liver, his mind and general metabolism. Advanced liver disease, in itself, can affect the functions of the brain and mind due to a complication termed hepatic encephalopathy. This would add to the problems from schizophrenia. Hepatitis B can be an insidious disease. At times it causes no obvious symptom that can lead the doctor to suspect abnormality in the liver. It is often detected on incidental examination of the blood. This may be one reason why your doctor did not suspect hepatitis initially. Should his abnormal behaviour and current serious but stable state be due to hepatic encephalopathy, there is a good chance that he may improve under treatment. I suggest you consult a senior gastroenterologist and neurologist in your neighbourhood to determine whether there was, indeed, any medical negligence.