Lack of post-operative care after Wrist Surgery: NCDRC upholds State Commission order, doctors told to pay Rs 7.8 lakh compensation

New Delhi: Upholding the State Commission's order, the National Consumer Disputes Redressal Commission (NCDRC) recently opined the doctors of Om Sai Hospital guilty of medical negligence for not providing post-operative care was not as per standard reasonable practice.

Therefore, the treating doctors need to pay Rs 7,80,000 compensation to the complainant who faced deformity in her hand after the dislocation of her elbow got missed by the treating doctors.

In this context, the top consumer court also noted that after facing the deformity of the right hand, the complainant, who was a working woman, had filed a complaint in the Maharashtra Medical Council, Mumbai against Dr Pareswar. Surprisingly, for one year the MMC didn’t take any action, but after one year, sent a letter to the Complainant that the MMC has not taken any action as the Complainant has not fixed Court stamp of Rs.10/- on the affidavit.

"It was not expected from MMC, which is a Professional Regulatory body to delay on trivial technicality," observed the NCDRC bench.

The matter goes back to 2011 when the complainant had sustained injuries to right wrist and elbow due to accident and thereafter she had approached the Om Sai Hospital and consulted an Orthopaedic surgeon Dr Rathod. Thereafter, the doctor had performed K-wire fixation surgery of lower end radius fracture and plaster was also applied.

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However, since the pain persisted in the elbow joint. So, the complainant consulted another Orthopaedic Surgeon Dr. Mhatre who opined that it was a case of comminuted Colle's fracture right hand and the doctor allegedly opined that the previous Orthopaedic surgeon as well as the Radiologist had missed the elbow injury (dislocation and fracture).

Thereafter, being aggrieved by this, the Complainant approached the District Consumer Forum, Thane and partly allowing the complainant, the District Commission directed the doctors to pay Rs 3 lakh compensation to the complainant.

Being aggrieved by this, the doctors approached the State Commission and after considering the matter, the State Commission enhanced the compensation. Accordingly, the doctors had been directed to pay Rs 4,80,000 towards loss of income of the original complainant, along with the Rs 3 lakh compensation as directed by the District Commission. 

Challenging the State Commission's order, the doctors approached the NCDRC bench the counsel for them argued that the patient had approached them with the fracture of lower end of Radius and therefore K -wire fixation and reduction were required for stable elbow.

The minor dislocation of elbow was corrected under anaesthesia. Above elbow plaster of paris slab was given. After plaster removal, physiotherapy was advised and regained 0- 95 degree movement at elbow joint. It was within acceptable range, which clearly indicates the elbow dislocation was treated successfully, submitted the counsel for the doctors while pointing out that the patient's limb was saved and stiffness had been reduced. The restricted movements and disability cannot be due to dislocation of elbow, submitted the counsel.

Meanwhile, the Amicus Curiae argued that the doctors had missed the right elbow injury, which was not treated in time, ultimately resulting in deformity to the patient. She became incapacitated and lost her job, pointed out the Amicus Curiae.

After perusing the medical record, the NCDRC bench noted that the Discharge card from the treating hospital revealed the diagnosis as "Fracture Lower end of radius Right wrist (Intra-articular)". As per the Operative notes “Closed reduction with k wire fixation done under brachial block".

The top consumer court noted that even in the follow up notes, nothing was mentioned about the condition of the right wrist and if any treatment had been given to the right elbow injury or not.

"It is surprising to note that according to the OP-2 "minor elbow dislocation was corrected under anaesthesia and above elbow POP slab was given to the patient”. But, it was not corroborating with the actual notes in the discharge card and the consent form. We have gone through the medical literatures and Campbell's Operative Orthopaedics on the subject of Elbow dislocation/fracture. There is no terminology such as MINOR / MAJOR elbow dislocation," the NCDRC bench noted at this outset.

The bench also considered the opinion given by other doctors whom the complainant had consulted. Referring to the Fracture Radial Head with elbow dislocation the notes of those doctors mentioned that "Though clearly evident on first X Ray (29.07.11) NOT NOTED By Radiologist and Ortho Surgeon."

In early 2014, the Complainant consulted Nair Hospital, Mumbai wherein it was diagnosed as “a case of unreduced Fracture dislocation of Right elbow”, noted the Apex consumer court bench.

Taking note of several other reports by doctors, the NCDRC bench noted, "...it is clear that there was dislocation of elbow since 29.07.2011, which was missed by OP-2 and remained untreated."

Referring to the relevant medical literature, the bench further observed, "The “terrible triad injury” of the elbow, the main objective in the management of such injuries is to restore the stabilizing bony structures of the elbow to convert a complex dislocation of the elbow joint into a simple one. However, proper identification of these lesions is quite demanding and their early management is a favourable prognostic factor for final outcome. Most TTI are managed surgically, and good results are achievable using a standard treatment protocol that includes fixation of the coronoid fracture, fixation or replacement of the radial head, and repair of the lateral collateral ligament (LCL)."

Therefore, holding the doctors guilty, the bench mentioned in the order, "In the instant case, the OP-2 operated the patient but the post-operative care was not as per standard reasonable practice."

So, upholding the State Commission order, the NCDRC bench dismissed the revision petition.

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-lack-of-post-operative-care-201504.pdf

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