Negligence in care of diabetic patient: NCDRC upholds Rs 10 lakh compensation to patient whose fingers got amputated due to gangrene

New Delhi: Opining that there was failure of duty of care, the National Consumer Disputes Redressal Commission (NCDRC) recently upheld the State Commission order holding Mata Chanan Devi Hospital guilty of negligence while providing treatment to the patient.

During the treatment, the patient developed gangrene in her hand during the ICU stay at the treating hospital and she later had to get the fingers of her hand amputated at Apollo Hospital. While considering the matter, the NCDRC bench has upheld the Rs 10 lakh compensation awarded by the State Commission.

The matter goes back to 2001, when the Complainant, who suffered vomiting and general malaise, had been admitted to Mata Chanan Devi Hospital. There, Dr Jain had examined her. 

It was alleged in the complainant that despite informing Dr Jain about her diabetic status for the last 4-5 years, the doctor had allegedly advised to put the patient on glucose drip instead of saline.

Thereafter, her condition deteriorated and the doctor maintained silence when he had been questioned why the patient had been given glucose. Soon after, the blood glucose level shoot up to 465% and the patient became pale. Allegedly the doctor did not make any attempt for reducing the blood sugar.

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After 1 hour, at about 2.00 pm, the patient had been shifted to ICCU. X-ray chest had been taken and it showed features of broncho-pneumonia. The patient suffered respiratory arrest, she was intubated and put on ventilator. Meanwhile, Dr Chhabra visited the patient and advised Dr Jain to tie up the hands of the patient with the bandage to the fence of the bed to avoid pulling of urinary tube. It was alleged that the hands of the patient had been tied to the bed from 2.00pm till next early morning and it led to swelling and impaired circulation in hands. It resulted in to gangrene of the left hand and the fingertip of the left had allegedly turned bluish purple, the fingers became stiff and had no life.

Allegedly, the doctors delayed to examine her cyanosed left hand and the patient became very weak and drowsy. Since there were no super specialists available in the hospital and the condition of the patient deteriorated further, she had been shifted to Apollo Hospital. At Apollo, the clinical notes mentioned that there was gangrene of the left hand up to the left wrist possibly as a result of long term compression of blood flow, because of venous edema.

After shifting the patient from the ICCU to private ward, Dr Chacko, the senior Vascular Surgeon had advised 10 days of treatment of gangrene by hyperbaric oxygen therapy, which was very expensive. Therefore, the fingers of the left hand had to be amputated.

Being aggrieved by the medical negligence of the doctors of Mata Chanan Devi Hospital, the complainant approached the State Commission, Delhi.

On the other hand, the hospital denied any negligence during the treatment of the patient and it was submitted that the patient had come to the hospital in a very critical stage and stayed in the hospital for less than 24 hours, without giving reasonable time for the treatment. However, she stayed in Apollo Hospital for 2 weeks and amputation was done after 20 days of her leaving the Mata Chanan Devi Hospital.

While considering the matter, the State Commission allowed the Complaint with a direction to the hospital to pay Rs 10 lakh as compensation along with interest @9% per annum. In addition, the State Commission had also sent a copy of the Order to the Medical Council of India for initiating proper action against Dr Jain and Dr Chhabra.

Both the Hospital and the Complainant approached the NCDRC bench challenging the State Commission order. While the for Complainant prayed for an enhancement of compensation to Rs 50 lakh, the Hospital prayed for setting aside the order.

After perusing the Medical Record, the top consumer court referred to the issue of development of gangrene of fingers of left hand and noted,

"it is pertinent to note that the Complainant’s husband Mr. Vinod Kumar, in his affidavit of evidence, stated that at the time of discharge, Dr. Sudhir Chhabra at OP hospital did not disclose that the patient was suffering from gangrene because of wrong instructions i.e. tying of hand. Even the Medical Superintendent Dr. Kochhar was also reluctant to allow the patient to go to Apollo Hospital as it would have exposed their wrong treatment and gross negligence. This evidence was not rebutted by the OP hospital."

Further referring to the fact that the Complainant took LAMA discharge and admitted his wife in the Apollo Hospital the NCDRC bench also observed, "The doctors of OP have not issued discharge summary, which is a deficiency on the part of the OP Hospital. The OP Hospital did not issue the discharge certificate at the time of referring to the Apollo Hospital."

The bench also referred to the discharge summary of the Apollo Hospital, New Delhi and noted that one of the diagnoses made was “ischemic necrosis – left hand”.

Noting that during hospitalisation, she had also been examined by respiratory consultant, endocrinologist and vascular surgeon, the top consumer court observed that it was also recorded that “she on admission was also found to have gangrene of left hand possibly as a result of long term compression of blood flow because of venous edema”.

"On bare reading of the findings of Apollo Hospital, the inference can be drawn that the gangrene was developed due to tight tying of the hands gangrene in whole night on 29.04.2001. It went unnoticed and unmonitored throughout the night by the ICU staff, it amounts to failure of duty of care. The higher duty of care was expected from the ICU staff as such the instant patient was critical," noted the Apex Consumer Court.

Holding the hospital guilty, the bench further observed,

"Considering the entirety of the case, the patient was a known case of diabetes mellitus (NIDDM) and was admitted in OP hospital on 29.03.2001 and got discharged LAMA on the next day. She stayed there for 24 hours only. During that period, her condition was critical due to highly diabetic status. I don’t accept the contention of the Complainant that the doctors have not taken steps to reduce the blood sugar of the patient is not acceptable. From the medical record, it is evident that proper doses of insulin were given and the doctors efficiently managed the critical condition of the patient. However, she developed gangrene of fingers in left hand during her ICU stay. The possibility of such gangrene was due to compromised state of the patient (diabetic, ketones and generalized infection - septicemia). But the evidence of patient’s husband about tying the hands cannot be brushed aside. It was the onus upon the OP to explain the cause of gangrene, but failed to prove."

"Based on the discussion above, I find there was failure of duty of care from the ICU staff in the OP hospital. The Order of the State Commission is reasoned and awarded just and adequate compensation to the Complainant. I do not find any reason to enhance the compensation," it added.

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-rs-10-lakh-compensation-201563.pdf

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