Patient loses fingers after vasopressors treatment: Hospital, Doctors slapped Rs 6 lakh compensation for medical negligence

Further, the patient claimed that due to the wrong medical treatment given to the complainant, he sustained loss of his fingers in the right hand i.e., thumb, index finger, and middle finger during the treatment.

It was argued that even though there was no complaint regarding urinary infection or kidney failure, the treating doctors provided dialysis treatment. The complainant alleged that the treating doctors were not specialists in urology, and they provided wrong medical treatment due to which he permanently lost three fingers on his right hand and had to seek further treatment at Ganga Hospital, Coimbatore, where he was advised for plastic surgery. Filing the complaint before the District Consumer Court, the patient sought compensation of Rs 33,14,000.

On the other hand, the hospital and the treating doctors denied the allegations of negligence, and claimed that the complainant suppressed material and factual aspects in order to make unlawful gains. 

They contended that the complainant did not approach the treating doctors for any simple fever, but he was actually suffering from "septic shock" and required recurrent management under periodical monitoring of vital parameters as he was already a type II Diabetes Mellitus patient and suffered from Pyelonephritis.

It was submitted that when the complainant approached the treating hospital, he had reached the third stage of sepsis namely septic shock, diagnosed during the initial prognosis. Since complications of septic shock treatment are the occurrence of gangrene, the patient was started on antibiotics fluid resuscitation, vasopressors, and oxygen supplementation.

The hospital and the doctors submitted that the Vasopressor drug therapy is a universally accepted medical protocol and is frequently required to achieve hemodynamic stability and support the patient in life-threatening situations such as shock, and the same protocol was followed in the case of the complainant also.

Continuous high-dose infusion of vasopressors (vasopressin and nor adrenaline) can induce peripheral vasoconstriction. Vasopressor induced tissue ischemia and gangrene, skin necrosis typically appears on the tip of the fingers and toes. In view of severe LV dysfunction of the Complainant recovering cardiogenic shock, nonoperative management was considered. It was stated that life-saving vasopressors, can result in digital ischemia and necrosis. Using a tiered approach helps in the management of this consequence while respecting the treatment paradigm of "life over limb," and safely performed with acceptable outcomes, submitted the hospital.

Arguing that necrosis of the extremities is a known risk associated with the use of life-saving vasipressors in critically ill patients such as complainant, the hospital and the doctors submitted that continuous high-dose infusion of Vasopressors affects the contraction of peripheral vasculature inducing peripheral ischemic conditions and plays an important role in the development of symmetrical peripheral gangrene (SPG).

Further, the hospital claimed that the complainant's condition at the time of discharge was comfortable, afebrile and at the time of discharge, the vascular and endovascular surgeon had advised and recommended medicines and advised to come for a review after 7 days with CRP, serum electrolytes, serum creatinine, FBS, PPBS reports. Medications were given for the demarcation of gangrene fingers and to prevent further episodes of blood clot. It was stated that the Complainant and his attenders were briefed on amputation of fingers wherein dry gangrene had formed as the next course of action after he had recouped with the inflammation of sepsis.

Submitting that they were not aware of further treatment at Ganga Hospital, the hospital and the doctors submitted that had the complainant come for a review, the next course of treatment and rehabilitation would have been done at the hospital as staged medical management and subsewuent procedures of amputation were already well informed to the complainant.

While considering the complaint, the consumer court noted that even though the treating hospital and the doctors contended that all medical procedures and formalities were followed in the treatment of the complainant, they failed to answer the main contention of the complainant that for the kidney problem, which was allegedly diagnosed, no nephrologist was treated the complainant and the specialist of the treating hospital (DM Nephro) did not treat him.

"If anything regarding the disease of kidney, only the Urologist or Nephrologist expert/specialist should have treated the complainant for the alleged ailment regarding kidney or urinary infection of the Complainant but no such Urologist or Nephrologist have treated the Complainant in the Opposite Party No.1 hospital. Further it was contention of the Complainant that no single document including case record, nurses notes or doctor’s order/progress notes or Daily Assessment Chart or Gross Consultation Record form or daily counselling record form has any recording about the alleged treatment given for the Complainant’s kidney problem by any Nephrologist of the Opposite Party No.1 hospital. Such contention of the Complainant is not properly answered on the side of the Opposite Parties with sufficient material evidence and with acceptable reason. Hence the contention of the Complainant is found to be reliable," noted the Consumer Court.

Further, the Commission noted that the Complainant's contention that they were not informed regarding the procedure to be followed and the consequential repercussions of induced symmetrical Peripheral gangrene that may ensue on administering of Vasopressor, was not properly answered by the treating hospital and the doctor.

"...no document is filed on the side of the Opposite Parties to show that the Complainant or his attenders were informed about the consequential repercussions of induced symmetrical Peripheral gangrene that may ensue on administering of Vasopressor," observed the Consumer Court.

The Commission also observed that the hospital and the doctors did not address the complainant's contention that no single document was filed to show that dialysis was done to the complainant at any point in time during his medical treatment by any of the treating doctors.

"Further, it was the contention of the Opposite Parties that the Complainant was suffering from Type II Diabetes Mellitus and had undergone treatment for Pyelonephritis elsewhere earlier but the Complainant has contended that no such treatment was undergone by the Complainant. Further the Opposite Parties having admitted that continuous high-dose infusion of vasopressors (vasopressin and nor adrenaline) can induce peripheral vasoconstriction and Vasopressor induced tissue ischemia and gangrene, skin necrosis typically appears on the tip of the fingers and toes, such treatment ought to have been avoided for the Complainant by the Opposite Parties which resulted in the loss of Complainant’s three fingers in his right hand. The Opposite Party doctors ought to have taken a reasonable care in the treatment of the Complainant in choosing a method or procedure of treatment but they failed to do so and it resulted in the causing of damages to the Complainant where the Complainant had permanently lost his three fingers in his right hand due to the medical negligence of the Opposite Parties No.2 to 5 (4 doctors) in the Opposite Party No.1 hospital," held the Commission.

The consumer court held that the complainant had proved the medical negligence committed by the treating hospital and doctors with sufficient material evidence. On the other hand, the commission observed that even though the hospital and the doctors relied upon medical literature to prove their case, they failed to answer the above-discussed contentions of the complainant. 

"In a case of medical negligence, the factors namely (i).duty to care, (ii). breach of duty, (iii). cause of injury and (iv). damages has to be taken in to consideration while deciding the case of alleged medical negligence. In the present Complaint, the Complainant has proved with sufficient material evidence that the Opposite Parties failed in their duty to care the Complainant during his medical treatment and the Opposite Parties have breached in their duty. The Complainant has proved the cause of injury and its damages, where he lost his three fingers in his right hand due to the wrong medical treatment given by the Opposite Parties. Though the Opposite Parties relied upon the medical literatures to substantiate their case, the same would not support the case of the Opposite Parties," observed the Commission.

Referring to the Supreme Court orders specifying the duties that a doctor owes to the patient, the Commission observed, "In the instant case, the Opposite Parties failed to exercise the required ordinary skills and standards while treating the Complainant in the Opposite Party No.1 hospital and Complainant has proved the negligence on the part of the Opposite Parties No.2 to 5 with sufficient material evidence. For the act of medical negligence committed by the Opposite Parties No.2 to 5 who are the doctors of the Opposite Party No.1 hospital, both the Opposite Parties No.2 to 5 and the Opposite Party No.1 hospital are jointly and severally liable. From the above, we find that the Complainant has proved the medical negligence committed by the Opposite Parties No.1 to 5 and the resultant damage caused to the Complainant and consequently this Complaint against the Opposite Parties No.1 to 5 is liable to be allowed."

Accordingly, the Commission directed the doctors and the hospital to jointly and severally pay the complainant Rs 6 lakh as compensation and Rs 10,000 as costs of litigation.

"In the result, this Complaint is partly allowed. The Opposite Parties No.1 to 5 are directed to jointly and severally pay the Complainant (i). a sum of Rs.5,00,000/- (Rupees five lakh only) towards compensation for medical negligence committed to the Complainant, (ii). a sum of Rs.1,00,000/- (Rupees one lakh only) towards compensation for physical and mental agony caused to the Complainant and (iii). a sum of Rs.10,000/- (Rupees ten thousand only) towards cost of this Complaint within two months from the date of this Order, failing which the compensation amounts stated above in (i) and (ii) shall carry interest at the rate of 10% per annum from the date of filing of this Complaint, that is, from 10.03.2025 to till realization," ordered the Commission.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/tn-drdrc-rs-6-l-compensation-296681.pdf

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