Loss of Thumb Due to Medical Negligence: Consumer Court Orders Gujarat Hospital to Pay Rs 7.64 Lakh Compensation to Patient

Mumbai: The District Consumer Disputes Redressal Commission at Central Mumbai recently directed a Vapi-based hospital and its two doctors to pay Rs 7.64 Lakh to a patient, who lost his thumb while undergoing treatment at the facility for skin ailments.

Holding the Urmil Eye Hospital And Skin Cosmetic Laser Center and its doctors guilty of medical negligence, the Commission directed them to return the entire cost of treatment i.e. Rs 4.64 L to the Complainant along with a 9% interest rate from 2015. Further, they were asked to pay Rs 3 lakh for causing mental agony to the patient and another Rs 15,000 as litigation charges. 

The history of the case goes back to 2012 when the complainant suffered from white spots on his skin. Seeking a permanent cure, he approached the treating hospital and its doctors for treatment. The treatment involved injections, laser exposure, and blood reinjection, accompanied by prescribed creams and medications.

Medicines were injected into the said white spots using a syringe and then the spots were exposed to Laser Rays. Thereafter, about 10 ml. of blood was extracted from the Complainant's body to conduct some medical process on the extracted blood. Following this, the processed blood was used to be re-injected in the said white spots using a syringe. Along with this, creams, oil, and ointments were used on the said spots and oral medication was also prescribed, the Complainant submitted.

The treatment started in May 2012 and on 15th January 2013, the Complainant was injured by a syringe to the right-hand palm's middle finger. On the same day, blood was extracted and then re-injected in the said white spots including the white spots on the middle finger and the thumb of the right palm.

The following day, the patient suffered severe pain, swelling, and black spots and when this was informed to the doctor, he advised painkillers but allegedly did not assess the injury in person. The condition worsened, and ultimately the patient was referred to another hospital, where another doctor diagnosed gangrene in the right thumb. 

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Based on the advice of the treating doctor and the doctor at the second hospital, the complainant was admitted to Hariya L.G. Rotary Hospital at Vapi in ICU. Thereafter, the patient's right thumb was partially amputated and up to the first phalanx was removed as the gangrene had set in deep. This was the only way to save the right hand. However, since, the gangrene was spreading and the oxygen therapy was unavailable at the Rotary Hospital, the doctors advised the patient to approach a larger hospital and allegedly discharged him without providing the medical treatment papers. 

Following this, the patient was admitted to another hospital, where the rest of the right thumb (first Metacarpal) and first web space of the right hand were removed and the treating doctors declared him out of danger. Then the patient underwent another connected surgery at Karuna Hospital, where holes were drilled at the phalanges of the other four fingers in the right hand of Complainant to facilitate proper blood circulation. 

As per the complainant, even today, he is required to undergo further treatment following the amputation of the first metacarpal and first web space. He claimed to experience absolute stiffness in the wrist, rendering the other fingers of his hand immovable and useless.

He claimed that due to the negligence of the treating hospital and doctors, he lost his right hand and therefore filed the complaint. He submitted that even though he had informed the doctors and hospital that he was a diabetic patient, the potential risks, especially due to the Complainant's diabetic condition, were not disclosed/ explained by them.

The complainant alleged that the hospital and doctors did not take necessary precautions like noting the sugar level of the Complainant, did not take required precautions to disinfect the syringe and other medical tools used for the treatment, did not sterilize his skin where the medicine was to be injected. He also claimed that the initial treatment exacerbated the white spots and caused additional harm.

Therefore, filing the consumer complaint, he demanded compensation of Rs 4,64,787 for medical expenses along with interest at the rate of 18% per annum, compensation for ongoing and future follow-up treatment expenses, and Rs 5 lakh for mental and physical harassment and litigation costs.

On the other hand, the doctors and the hospital denied the accusations of negligence and contended that the patient lost his thumb due to long-standing diabetes mellitus and not due to any action by them. It was submitted by the doctors that gangrene was a known risk in diabetic patients. Diagnosed with vitiligo, the patient was informed about the disease and the treatment, which included oral medication, local applications, phototherapy, and autologous PRP injections. As per the hospital and doctors, the patient showed good response and the treatment continued with satisfaction till January 2013. They also claimed that the disease management and potential risks, especially for diabetic patients, were fully explained to the patient.

While considering the matter, the Consumer Court noted that there was no dispute that the treating doctor administered the PRP injection and the patient suffered gangrene to the right-hand thumb of the patient and the hospital and doctors did not deny that the gangrene took place and the thumb was amputated in the subsequent hospital.

The Commission noted that the doctors and hospital submitted that the thumb amputation was due to diabetes mellitus and not because of the injections given. They also claimed that Gangrene was a documented risk for diabetics. Further, they had claimed that Joint stiffness was unrelated to PRP injections and could be due to various other reasons and that gangrene was a diabetes-related complication, or caused by atherosclerosis, peripheral arterial disease, smoking, trauma, or injury, obesity, Raynaud's phenomenon, and other conditions.

Taking note of these submissions by the hospital and doctors, the Commission noted that they did not produce sufficient material evidence to substantiate those reasons. 

At this outset, the Commission noted, "In fact, a detailed patient history and comprehensive blood tests are required, which have not been conducted by the Opposite Parties. The most probable cause of gangrene in the present case appears to be reason number vii) trauma or serious injury, which occurred immediately during the administration of the PRP injection. This conclusion is supported by the medical records dated 18/01/2013 from Shraddha Hospital and the discharge summary dated 24/01/2013 from Haria L G Rotary Hospital."

While the other potential causes of gangrene remained unproved, the Commission noted that

 "the Complainant was injured during the treatment to right hand middle finger and pain in right thumb while OP No. 2 was administering the injection on 15/01/2013, which we consider the most probable cause of the gangrene in the Complainant's right thumb, ultimately leading to its amputation."

Further, the Commission observed that even though the hospital and the doctors claimed that all the injections that were administered were sterile, single-use disposable syringes and needles, "the Opposite Parties have not provided evidence to prove this through any medical documentation or any expert report."

Holding the hospital and its doctors liable for medical negligence, the Commission noted, 

"Despite the claim that gangrene is rarely caused by injections, as per NCBI, and admitted by the Opposite Parties, it is also contended that accidents can happen. However, this was not an accident but rather a case of negligence, as the Opposite Parties failed to carry out thorough blood tests despite knowing that the Complainant was a diabetic patient before administering the PRP injection. More precaution was expected under these circumstances, thus there remains the possibility of gangrene due to the injections. If the Opposite Parties had taken due care, including disinfecting the syringe, avoiding injury, and conducting a proper medical history and diabetes assessment before injecting PRP, the Complainant might not have suffered the physical loss of the right thumb. This negligence on the part of the Opposite Parties directly resulted in the Complainant's injury and amounts to deficiency in services on part of the opposite parties."

The Commission relied on Supreme Court orders in the case of Kusum Sharma & Ors vs. Batra Hospital & Medical Research Centre & Ors, V. Kishan Rao vs. Nikhil Super Speciality Hospital & Anr, Jacob Mathew vs. State of Punjab & Anr and noted, "These judgments illustrate that while expert testimony is important in medical negligence cases, the facts and circumstances of the case can independently demonstrate negligence when they are sufficiently clear and compelling. In the present case the facts itself speaks about it. The conditions were Opposite parties referred Complainant from one hospital to another for treatment of gangrene that is after administering of PRP injunction to Complainant is a direct consequences of Opposite parties treatment and their breach of standard care, resulting amputation of right hand thumb which was vital cause factor."

The Consumer Court observed the submission of the doctors and the hospital stating that gangrene was not caused due to syringe injury or because of the use of Platelet Rich Plasma (PRP), but because of long-standing diabetes, which caused peripheral arterial disease end-arteries and blockage of blood vessels. Gangrene is thus seen in the periphery of the limb in chronic diabetes patients, such gangrene requires amputation.

However, the Commission noted that the hospital and the doctors at such a stage failed to take a comprehensive assessment of the patient's overall health, especially focusing on the status of their diabetes and any complications such as peripheral arterial disease, detailed medical history of his advice slip/prescription/ OPD papers.

"There is no pre procedure counselling and post procedure care written/shown on prescription by the Opposite Parties, neither noting of informed consent about potential risks associated with their diabetes condition on the medical papers. There is no referral advise to specialist about the same in the medical papers appears. Hence the submission, literature, Wikipedia notes and text extract, and case laws filed by the OP. No.1 & 3 are not considered," it further noted.

While the consumer court opined that the hospital and doctors had a duty to fully inform the Complainant about the potential risks associated with the treatment, and it is essential to take the patient history and write it down on the OPD papers, the "Opposite Parties only conducted the RBS on 03/10/2012, neither embodied the fact related to history available or non-available. The prescription provided do not disclose such information which is mandatory at the time of examination and treatment. In absence of hospital papers of OP No. 3 written down during the period of treatment we cannot believe, the theory that Complainant has never disclose the history of diabetes and as per the case relied by Complainant."

Perusing the evidence, the Commission noted that the hospital and doctors continued treatment without adequate precautions to mitigate the risks due to the Complainant's diabetes. It further noted that the lack of sterilization protocols, as claimed by the Complainant, and the initial response to the severe symptoms exhibited by the Complainant on January 16, 2013, indicate a failure to adhere to standard medical practices.

Therefore, the Consumer Court opined, "The gangrene and subsequent amputation were directly linked to the complications arising from the treatment, establishing a causal connection between the treatment provided by the Opposite Parties and the injuries sustained by the Complainant."

Holding both the doctors and the hospital jointly and severally liable for failing in their duty of care and for displaying a lack of necessary precautions in treating a diabetic patient, the Consumer Court directed them to return the cost of treatment expenses to the Complainant and also pay compensation for causing mental agony.

"The Opposite parties individual liability cannot be assigned, the Opposite Party are held vicariously liable, jointly and severally and declared to have engaged in deficiency in service and unfair trade practice under the Consumer Protection Act, 1986. The Opposite Parties are directed to pay the Complainant a sum of Rs. 4,64,787/- towards medical expenses relating to treatment, hospitalization, medicines etc. which he has incurred with an interest of 9% per annum from the date of filing the complaint until realization. Opposite Parties are further directed to pay Rs. 3,00,000/- (Three lakhs only) as compensation for future loss of earning, medical expenses, mental and physical harassment. Opposite Parties are directed to bear the litigation costs of Rs. 15,000/- for legal and incidental expenses. Opposite Parties are directed to comply with this order within 45 days from the date of this judgment. Failure to comply with the order shall attract further interest of 18% per annum from the date of filing the complaint until realization," it noted.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/central-mumbai-consumer-court-244413.pdf

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