Amputation of Newborn's Leg- Gynaecologist, Paediatric surgeon slapped Rs 50 Lakh Compensation for negligence

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently directed two doctors belonging to two private hospitals in Patna to pay Rs 50 lakh compensation to a woman for medical negligence leading to the amputation of her newborn son's leg.

After being treated for chest infection and breathing problems, initially, the child's condition stabilized. However, soon afterwards, the complainant noted discolouration of the child's left foot. Ultimately, the newborn was transferred to Sir Ganga Ram Hospital, where the leg had to be amputated.

The history of the case goes back to 2007 when the complainant had delivered a baby boy in the hospital of Dr. Sinha, a Gynaecologist. However, the baby was suffering from chest infection and breathing problems and required consultation with a child specialist. Therefore, advice was sought from Dr. Kumar, a Paediatrician surgeon and after that the baby was admitted to Dr. Kumar's hospital (Kids Care) in a Neonatal ICU on the ventilator. 

After stabilization, the baby was put on intravenous (IV) feed on the 3rd day, and on the 6th day, while breastfeeding the child, the complainant noticed that the baby's left foot was blue. After this was brought to Dr. Kumar's notice, he conducted a Doppler test after much persuasion. Consequently, the child was taken to Sir Ganga Ram Hospital, where despite treatment for thrombus in descending aorta and treatment for plasminogen activor, the left foot below the knee had to be amputated as it had become gangrenous. 

Thereafter, filing a consumer complaint before the State Commission, the mother alleged that the two doctors had failed to provide adequate, proper and timely care to the new born baby and prayed for Rs 50 lakh compensation along with interest and litigation costs.

Earlier, while considering the matter, the State Commission had dismissed the complaint noting that the woman submitted no medical expert opinion to show that the treatment provided by the doctors was wrong or that the medicines given to the patient increased the infection.

Challenging the State Commission's order, the complainant approached the NCDRC bench and contended that based on the record, neither the Paediatrician nor Neonatologist was present at the Hospital of Dr Sinha at the time of birth and therefore, the baby was required to be moved to the Nursing Home of Dr. Kumar. 

Further, the appellant contended that due to heavy doses of medication, inappropriate treatment and inordinate delay in treatment by Dr. Kumar and medical negligence of the treating doctors, the baby's left leg had to be amputated. 

It was also argued that Dr. Sinha himself had admitted that at the time of birth, no qualified Neonatologist or Pediatrician were present and since the newborn started having breathing problems within a few minutes of birth, Dr. Kumar had to be called.

The complainant also alleged that despite observing the blue colouration of the left foot on the 6th day, Dr. Kumar failed to take the appropriate steps immediately and conducted the Doppler test only on the 8th Day whereafter the report was sent to Sir Ganga Ram Hospital, New Delhi and agreed to discharge the child after much persuasion. The complainant alleged that Dr. Kumar submission that the blue colouration was noticed on the 8th day of admission was incorrect and contrary to the Treatment-Cum-Progress Chart which was the record of the hospital itself. 

Apart from this, the complainant also contended that the conclusion that the child had developed thromboembolism was also incorrect since it was evident from the record that on the 8th day at around 10 PM, Peripheral Cyanosis was recorded in the treatment chart.

On the other hand, the treating doctors argued that as per the Discharge Summary issued by Sir Ganga Ram Hospital, New Delhi, after being treated for respiratory distress and being on ventilator for three days and being on IV fluids and antibiotics, the patient (child) had started to accept feeds by the 6th day and therefore, the line of treatment was correct. As per the doctors, the parents reported of the discolouration of the left leg only on the 8th day. They also stressed that no doctor at Sir Ganga Ram Hospital found any medical negligence on their part and the same was evident from the discharge summary.

While considering the matter, the top consumer court perused the Treatment cum Progress Chart of the Kids Care Hospital and noted that on the 6th day, the chart noted at 10 PM "Pink Peripheral Cyanosis" and thereafter on 21.12.2007 at 4:30 PM it was recorded as "Change of colour of status of left leg" and "Opinion of Pediatric Surgeon and Cardiovascular Surgeon should be taken" followed by a remark at 10 PM stating "Left foot pale, cold. Surgical Opinion."

The Commission noted that the patient was discharged on 21.07.2007 and as per the Discharge Slip dated 21.02.2007 issued by the "Kids care" hospital, the baby was admitted on 11.02.2007 and was given treatment including IV fluid, injections, and symptomatic with ventilation for three days. Respiratory distress had settled by 6th day and baby had started breastfeeding for two days. investigation done included Colour Doppler of Left Limb which showed ‘No pulsation of dp and post lipid artery’. The diagnosis was ‘RDS with avascular nacrosis of right foot fingers’. Advice on discharge was ‘Refer to higher center for needful’.

Meanwhile, the Discharge Summary of Sir Ganga Ram Hospital mentioned that at the time of admission, "Left foot was gangrenous with crepitus palpable. Line of demarcation present 2 inches above the left ankle joint. Rt lower limb was also cyanosed." A CT angiography was done which revealed a large occlusive thrombus in the descending aorta and extending in both lower limbs. Baby was given a trial of tissue plasminogen activator, which failed to show any response. The coagulation profile was normal and sepsis work up revealed candida paracilosis from blood and urine cultures which was treated with amphotericin B.

Regarding the issue of expert medical opinion, the Commission noted that the case was not a complicated matter of transplant of an organ or surgery. It was essentially whether the newborn child of the complainant who was under care of Dr. Kumar in his Nursing Home, was detected to be suffering from Peripheral Cyanosis in time and whether the doctor, after diagnosis either extend the treatment as per prescribed medical protocol or refer him to a higher centre for treatment.

"The moot issue is whether a duty of care was owed by the Respondent No. 2 (pediatric surgeon) as a medical professional and whether this duty was breached resulting in harm to the patient as a result of which he suffered damages," observed the Commission.

Opining that the paediatric surgeon failed to provide duty of care owed to the patient, the Commission observed,

"From the facts of the case, it is patently manifest that the newborn child/patient was in the care of the Respondents and therefore a duty of care was owed by them to him. By delaying the recording of the fact of Peripheral Cyanosis and the conduct of the Doppler Test including consultation with another expert, Dr HK Verma, the duty of care was breached by the Respondent No. 2. This breach caused harm to and led to the damage suffered by the patient. Therefore, the case is eminently covered under the principle of res ipsa loquitur. The State Commission has clearly fallen in error in holding that there was no expert opinion produced and, on this ground, dismissed the complaint."

"It is also evident that the damage/harm occurred due to negligence on part of Respondent No. 2 in failing to act promptly and taking steps when Peripheral Cyanosis was detected since the patient was in his exclusive care at that point of time. The contention of Respondent No. 2 that the patient was found to have had an thrombosis in aorta in the abdomen for which thrombotitis was conducted at Sir Ganga Ram Hospital is essentially to contend that the cause of amputation was not Peripheral Cyanosis which was detected while the patient was in his care. It is, however, clear from the records of Sir Gangaram Hospital that the patient was admitted on 22.07.2007 with a gangrenous with crepitus palpable left foot and right lower limb also cyanosed although haemodynamically stable. Thus, it is apparent that the damage/harm (amputation of the left leg) would not have occurred without negligence of Respondent No. 2. It is also evident that Respondent Nos. 1 (gynecologist) and 2 had exclusive control over the circumstances that led to the damage that was suffered and that there was no contributory negligence on part of the patient/attendants," it further noted.

Therefore, the Commission opined that the State Commission acted erroneously in requiring an expert opinion when the matter was not a complex one warranting expert evidence but was rather one of adjudicating whether the conduct of the Doppler Test and reference to a higher centre for further treatment was done timely as per the duty of care imposed upon Dr. Kumar, the paediatrician surgeon.

"From the medical records of treatment in the hospital of Respondent No. 2 it is apparent that the patient’s discolouration of the left leg had indeed come on the daily Treatment-cum-Progress Chart. A Dopplers Test was done which revealed “arterial blockage due to thrombosis in aorta of abdomen and low level of protein in respiratory distress syndrome” as per the Respondents themselves," noted the NCDRC bench.

Referring to the doctors' contention that the diagnosis of Sir Ganga Ram Hospital was also that the patient required thrombolysis with tissue plasminogen and due to the failure of this treatment the left leg was required to be amputated below the knee, the Commission observed that from the records it was clear that at the time of admission to Sir Ganga Ram Hospital, the patient's "Left foot was gangrenous with crepitus palpable. Line of demarcation present 2 inches above the left ankle joint. Rt lower limb was also cyanosed."

Holding both the doctors guilty of medical negligence, the Commission observed,

"The contention of the Respondents that the patient was diagnosed correctly and on the correct line of treatment while under the care of Respondent No. 2 therefore cannot be accepted. There is no reference to any sepsis or gangrene in the Discharge Slip dated 21.02.2007 issued by Kids Care hospital. It is also evident that the Doppler Test was done after 10 th day of the patient’s left foot condition having been noted in the Treatment-CumProgress Chart. From the record, it is manifest that the instant case is covered by the principle of res ipsa loquitur. Accordingly, we hold Respondents 1 and 2 jointly and severally liable for medical negligence and deficiency in service in the treatment of the patient (newborn child of Appellant). For the aforesaid reasons, the First Appeal is liable to succeed and is accordingly upheld and allowed."

Accordingly, the Apex Consumer Court directed the doctors to pay Rs 50 lakh as compensation and Rs 50,000 as legal cost to the complainant.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/patna-doctors-rs-50-l-257329.pdf

Also Read: Thumb Amputation due to gangrene- Expert Evidence Vital in Determining Medical Negligence, says Court