Disability due to non-union of bones after ORIF: NCDRC absolves Punjab Hospital of medical negligence

New Delhi: Setting aside the order of the State Commission, which held held a Punjab based hospital guilty of medical negligence while performing open reduction and internal fixation (ORIF) on a patient, the National Consumer Disputes Redressal Commission (NCDRC) gave clean chit to the hospital.

Although the patient had alleged that he had to suffer disability because of non-union of bones, the top consumer court opined that "non-union or mal-union of fracture is a known complication, which could arise by improper follow-up, weight bearing or infection. The disability was not due to the negligence of treating doctor or hospital."

The matter goes back to 2010 when the complainant suffered fracture of right Radius and Ulna bones after meeting with an accident. Thereafter he was taken to Malwa Ortho Hospital and was operated for open reduction and internal fixation (ORIF). A few days after the operation, the complainant developed swelling and pain. When he approached the treating hospital, he was given some medicines but the condition did not improve.

Later, after conducting X-ray of the right hand, it was revealed that the bones of the patient were not properly fixed, screws and plates were loose and separated, moving freely. Thereafter, a second operation was conducted for removal of plates and the plaster of paris was fixed. 

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Therefore, the complainant alleged that while applying plaster, there was no union of fractured ulna bone and the complainant's hand bent towards one side. As a result, the patient became handicapped and he became unable to do his work properly. Following this, the complainant visited few hospitals in Rampura Phool, Amritsar and Sri Muktar Sahib. However, all those hospitals advised for another surgery.

Finally, after visiting Civil Hospital, Muktsar, the patient was declared to be 35% handicapped and a certificate had been issued in this regard on October 5, 2011. Since the patient was a teacher, he had to remain on medical leave during the time of treatment. Although the patient requested the hospital to pay the amount spent by him, the request had been refused and following this, the Complainant filed a complaint before the District Forum, Sri Muktsar Sahib.

While considering the matter, the District Forum relied upon the evidence of Dr. H.S. Sohal, Professor and Head of Department of Orthopaedics, Government Medical College, Amritsar. As per the evidence Government Rules pointed out that benefit of disability cannot be given if it falls below 40%. Since the disability of the complainant was 30%, the District Forum dismissed the complaint.

However, the State Commission Punjab allowed the appeal and directed the hospital and nursing home to pay Rs 1.5 lakh along with interest. Being aggrieved with this order, the hospital approached the NCDRC bench.

The apex consumer court noted that the complainant after suffering commutated fracture of both forearms and dislocation of wrist joint was taken to Bansal Nursing Home, where Dr. Jain performed ORIF surgery with DCP with bone grafting and G. Graft. Thereafter the complainant visited the hospital after 4 months when the X-rays revealed dislocation of plates. Consequently, Dr. Jain removed the plates and POP was applied and the patient was discharged. 

The consumer court further noted that the complainant was advised surgery if bones did not unite but the complainant ignored the advise. The bench also perused the statements on record given by the Officers and Doctors at Civil Hospital, Muktsar.

It was observed by the court that the Junior Assistant CMI, the In-charge of Disability Certificate issuing division stated that no record was available about the issuance of disability certificate by the Civil Hospital and no entry in the physically handicapped dispatch register. There was no serial number on the certificate.

Referring to the hospital records, the Commission noted that no application made from the complainant for issuance of disability certificate and no document regarding any tests carried upon him. Another statement of Rtd. CMO revealed that the disability certificate less than 40% disability shall not be issued.

"The certificate got signed from him in routine and it does not bear any number and even the certificate issuance register had no entry of issuance of such certificate between 14.09.2011 to 05.10.2011," noted the commission.

Apart from this, the Commission also referred to the third statement of Dr. H.S. Sohal, Professor and Head of the Department of Orthopaedics, Govt. Medical College, Amritsar, who was also Head of the Department for State of Punjab to issue disability certificate. Dr. Sohal had opined that no certificate can be issued without any number.

"Certificates can be issued if the disability even less than 40% but the benefits of disability and for compensation as per Govt. rules if disability of 40% or above. In the certificate, dislocation of Ulno Carpal joint was mentioned, but such joint never exists in body. He further opined that there was no negligence of the operating surgeon, the patient did not follow the instructions given by the operating doctor, such disaster can happen," noted the Commission.

Therefore, after perusing the Disability Certificate, which does not bear any serial number and appears to be a forged document and was issued without any authority, the Commission noted, "Thus, there is a possibility of the Certificate being procured in connivance with the officials of the hospital."

Referring to the RTI information, the Commission noted that the Complainant was Govt. School Teacher and he was on duty as a teacher taking regular classes and seminars. He also performed census work during the year 2010 and 2011."

Therefore, exonerating the hospital from charges of negligence, the Commission mentioned in the order,

"On the basis of foregoing discussion, it is evident that the treating doctor was a qualified Orthopaedician and performed ORIF as an accepted standard of practice. The non-union or mal-union of fracture is a known complication, which could arise by improper follow-up, weight bearing or infection. The disability was not due to the negligence of treating doctor or hospital."

The Commission, therefore, set aside the order of the State Consumer court and mentioned in the order,

"The State Commission erred by holding the OPs liable for the disability suffered by the Complainant. The Order of State Commission is set aside and the Revision Petition is allowed. Consequently the Complaint filed before the District Forum is dismissed."

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/no-medical-negligence-195412.pdf

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