Administration of Intra-arterial Injection instead of Intravenous: Doctor, Vimhans Hospital to pay Rs 20 lakh

New Delhi: The Delhi State Consumer Disputes Redressal Commission has directed Vimhans Hospital and physician attached to the hospital to pay Rs 20 lakh compensation the patient who was negligently administered intra-arterial injection instead of an intravenous one by the doctor.

The case concerns a patient, Amresh, who was taken to the hospital with complaints of vomiting and fever on 13.05.2003, when he was 12 years old. After observation, a doctor on duty administered one spoon of the syrup ‘phenargan’ to the patient.

Thereafter, Dr Sinha gave injection ‘phenargan’ IV, 25 mg in the brachial artery. Shortly, the patient complained of acute pain. At about 4 pm, he was discharged from the hospital, however, later at 5:30 pm the patient’s right hand had become blue.

Subsequently, he was rushed again to the hospital. After seeing the condition of the patient, Dr Sinha directed the father to take him to All India Institute of Medical Sciences (AIIMS) immediately. Doctors at AIIMS informed that the damage had been caused to most of the fingers due to wrong administration of injection and the same could not be reversed. It had caused gangrene. Doctors also asked the father to bring the patient next morning and show him to a cardiovascular surgeon. Next morning, the cardiovascular examined the patient and prescribed treatment.

Accordingly, the patient visited AIIMS regularly for a week. However, the treatment didn’t produce any results. On 06.05.2001, the patient was taken to Apollo Hospital, where Dr K K Pandey, a cardiovascular was consulted. Dr Pandey found gangrenous charges in the fingers of right hand and swelling of the forearm. Right radial artery was palpable thrombosis and spas of pulmar arch trances were suspected.

A Doppler test was conducted on 08.05.2001. On 28.05.2001 Dr Pandey advised the father to get the gangrenous portion of the fingers amputated. Hence, the patient was operated upon and fingers of the right hand from 2nd to 5th were amputated.

Aggrieved by the treatment received at Vimhans, the patient filed the complaint with the consumer forum contending that the doctor ought to have checked whether the injection was being administered in the vein or in the artery.

Submission of the complaint was that the doctor did not check if any swelling was there in the hand. He also did not adopt the standard procedure while administering the injection of phenargan. It was also alleged that the hospital and the doctor didn’t control the damage by referring the case to a cardiovascular surgeon who would have performed the emergency procedure.

Presenting his defense before the court, the doctor denied all allegations made against him. He submitted that the father had prior to bringing him to hospital given perinorm tablet and intravenous fluid. The child had developed complications for which he was brought to the hospital. The complication was drug-induced dystonia.

The doctor also submitted that the father was employed as a technician in the operation theatre of the Vimhans hospital. He was well conversant with medicines and administering injections etc. Besides drug-induced dystonia, the patient had complications of intravenous fluid given to him by his father at home. It led to ischemic damage to the hand of the complainant leading to amputation of the fingers.

The doctor further contended that he had administered the said injection through the cannula which was fixed on the back of the right hand over the anatomical snuff box. The appearance of gangrene and amputation of fingers could not be attributed to him. He denied that he had administered the injection in the brachial artery or anywhere near it.

Referring to the Doppler report, the doctor stated that the right brachial artery was structurally normal and bifurcating into the right radial and ulnar arteries. Only the distant part of the ulnar artery was found blocked.

In a separately written version filed by the hospital, it denied its vicarious liability while submitting that the doctor was not its employee as he was only a visiting consultant. It submitted that AIIMS was a necessary party as a major part of the treatment was carried out there. As regards the injection, it was administered intravenously as per medical records, the counsel for the hospital contended.

Meanwhile, the case was adverted to the expert committee of Dr P Kar, Director Professor of Medicine; Dr P N Aggarwal, Director Professor & Head and Dr Vandana Roy, Professor of Pharmacology from Maulana Azad Medical College, who opined,

“The phenargan injection has been given intra-arterial inadverntely which is also evident from the Doppler report. This has resulted in the gangrene of the fingers and ultimately amputation.”

After hearing all the arguments and keeping in view the expert opinion, the bench of honourable Judicial Member NP Kaushik, observed,

“In view of the discussion above we are left with no option to conclude that the child was given injection Intra arterial instead of giving intravenous. This injection caused gangrene. Child had to undergo amputation of second to fifth fingers of right hand.”

 In its conclusion, the bench held,

“I am of the view that compensation to the tune of Rs.20 lakhs shall meet the end of justice. Accordingly the complainant shall be paid an amount of Rs. 20 lakhs alongwith interest @7% per annum from the date of filing of complaint till the date of its realization. Out of this amount, 80% portion shall be borne by OP2 hospital and the remaining 20% shall be borne by OP1 doctor.”