Radial Nerve Palsy after Key Hole Surgery for fracture to humerus bone: Consumer Court slaps compensation on Doctors, Hospital

Kannur: The district consumer court, Kannur recently directed an Orthopaedic surgeon, a doctor and a hospital to pay compensation to a patient who had suffered radial nerve palsy after undergoing a keyhole surgery conducted by the doctors.

Apart from directing the doctors and the hospital to pay Rs 1,87,514, the cost of a second surgery at a second hospital, the consumer court also directed them to pay Rs 2 lakh as compensation and Rs 25,000 as the cost of legal proceedings.

The matter goes back to 2020 when the complainant fell in the bathroom, got injured and approached the consultant orthopaedic surgeon- Dr Raghavan. After undergoing an X-ray, it showed that the complainant had sustained a fracture to the left humerus bone. The treating doctor advised him to get admitted to Thalassery Mission Hospital and recommended that an operation was required to rectify the damage that occurred to the left humerus bone. 

The doctor further advised that through a keyhole surgery, the interlocking of the left humerus bone at the fracture shall be performed and convinced the complainant to undergo the operation immediately. 

Accordingly, the complainant was admitted to the hospital and the key hole surgery was performed by Dr. Raghavan and Dr. Azeez. However, after discharge, the complainant felt weakness in his left hand fingers and wrist after the key hole procedure. Allegedly, the treating doctor did not consider the problems despite the complainant informing the same. The doctor only suggested continuing the physiotherapy.

Based on the physiatrist's suggestion, the complainant underwent a nerve conduction study at Indira Gandhi Co-op Hospital. The study suggested that the complainant's left hand had Radial Axonal Neuropathy and Bilateral carpal tunnel syndrome. However, the doctor allegedly ignored the result and advised only to continue the physiotherapy.

Since there was no improvement, the complainant consulted a second doctor at Kochi, who diagnosed that the Complainant had Radial Nerve Palsy to correct which required a Radia nerve Exploration surgery. After that, the complainant took a second opinion from a Neurosurgeon at Mangalore and the doctor also gave the same opinion.

Then the complainant approached the Dept of Plastic Surgery at MBR Hospital and after a detailed diagnosis, the doctors confirmed immediate surgery. Accordingly, a second operation was conducted and the doctors at the MBR Hospital further informed the complainant that his damage was permanent and the radial nerve could not be fully corrected and therefore the damage would be permanent and the disability sustained would be for life long.

Filing the consumer complaint, the patient demanded compensation from the treating doctor Dr. Raghavan for the mental agony, and financial loss due to resigning from his job.

On the other hand, the doctor contested the complaint and submitted that he had conducted closed interlocking nailing of left humerus bone under C-arm guidance with all care and caution with the assistance of Dr. Azeez. It was submitted by the doctor that on the 2nd post-operative date, the patient was noted to have difficulty in extending fingers partially and the involvement of the radial nerve was identified which is a reported problem associated with fractures of mid shaft of humerus. 

Therefore, the patient was given a cock up splint and referred for physiotherapy consultation and explained regarding exercise patterns to improve finger movements. The patient was discharged with advice to continue physiotherapy exercises at home and to wear cock up splint and the patient was also advised for review for suture removal and physiotherapy evaluation.

On review consultation, suture removal was done and on clinical examination radial nerve was assessed, the condition was diagnosed as due to neuropraxia and as per accepted treatment protocol, he was advised physiotherapy as part of conservative management as neuropraxia usually improves on its own by three to six weeks conservative management.

It was submitted that the radial nerve neuropathy diagnosed on nerve conduction study was not caused due to any act or omission on the part of the doctors and there was no failure on their part in the management of the said condition. The fracture of mid shaft of humerus bone itself can cause nerve involvement likely to be manifested after surgery for which gentle home exercise programme/ physiotherapy is the initial accepted line of management and surgical intervention is necessary only if there is no improvement with conservative management.

Further, the doctors submitted that the complainant underwent radial nerve exploration and reconstruction or radial nerve contusion and it cannot be termed as due to any fault in interlocking nailing done by the doctor. Dr. Raghavan further submitted that the damage of radial nerve will be permanent and disability will be lifelong is not sustainable since there was no negligence or breach of duty on their part and no damage had been caused by the treatment given by them.

The consumer court noted that the patient alleged that the Radial Nerve injury happened to his left hand due to the screw that was fixed where the radial nerve close to the left humerus bone during the key hole surgery. The Commission further noted that the complainant proved the fact through the ENMG report dated 15.01.2020 that when he informed the treating doctor about the nerve conduction study, which suggested that his left hand had a Radial Axonal Neuropathy and Bilateral carpal tunnel syndrome, the doctor only advised to continue the physiotherapy and ignored the test result shown.

Taking note of the prescription issued by Dr. Azeez on 14.01.2020, the Commission noted, "...we can see that no prove diagnosis was advised to the patient to find out the reason for the present complaint of pain etc. Not even suggested to take X-ray. Simply given Neugaba Medicines for pain , and some other medicines."

The Commission further noted that the treating doctor did not mention about the report regarding the nerve conduction study in the prescription and only suggested physiotherapy and gave some medicines. Referring to the doctors' explanation that further evaluation with nerve conduction study would be considered if conservative management failed, the Commission noted that the nerve conduction study was done; on the same day and Radial axonal neuropathy which showed that on the review day itself, the patient had such a complaint. Further, the physiotherapy and cock up splint was started on 06.01.2020 itself.

"OPs submitted that if there was no improvement in applying cock up splint and doing physiotherapy , nerve conduction study has to be done. In such a situation , even after complaining about the complaint of feeling weakness in the left hand fingers and wrist of the complainant on the review day, and after seeing Ext.A10 report, no other treatment was advised by the OPs 1&2," noted the Commission.

It observed that after getting the Ultrasound Scanning report taken at Kasturba Medical College, Mangalore, the patient again approached the treating doctor and explained to him the present condition, reports and opinions of other doctors. As per the submission of the patient, then also the doctor opined to continue physiotherapy.

"From the action of complainant to approach 1st OP again and again, without availing treatment from any others, even after realizing the condition of his hand, seems he believe 1st OP that much. But from the medical records it is revealed that there was no improvement happened to the hand of complainant till 14/2/2020," noted the Consumer Court.

It also took note of the admission document at the second hospital where the 2nd operation was conducted, the Commission noted that the "patient had gross stiffness of shoulder, wrist and hand joints with oedema"

Referring to this, the Commission noted, "From the said facts itself it is revealed that there was no improvement to the patient to the left hand, after the surgery done by 1st OP at 3rd OP’s hospital."

The Commission noted that the expert doctor deposed that "if there is any radial nerve injury is suspected, cock up splint is used and it is one of the treatment for radial nerve injury." He further deposed that "if neuropraxia is not cured, a nerve conduction study can be done. Can the radial nerve injury caused by a fall? Yes, fall trauma etc."

It was noted by the Consumer Court that in this case, after applying the cock up splint and starting physiotherapy, the radial nerve injury was found by doing nerve conduction study at another hospital. The expert deposed that if radial nerve injury is suspected, cock up splint and physiotherapy can be advised.

"Here even after knowing about radial nerve injury through Ext.A10 report, 1st OP advised to continue the prior treatment. Till 10/2/2020 complainant continued the said treatment as per the advise of OPs 1&2. Ext.X1 shows that at the admission time at the Specialists hospital Kochi, the condition of nerve was, radial nerve palsy," the Commission noted.

During the cross-examination, the expert doctor opined that if the nature of the fracture is complicated through X-ray, that will be noted in the case record. Further, if there is pre-existing radial nerve palsy that will be noted in the case records. Further stated that in such case EMG test will be suggested, which will be noted in the case records. If there is suspected radial nerve palsy then cock up splint will be given.

However, the Commission noted that in this case, the report revealed that there was radial nerve palsy, even on the subsequent review dates the patient reported the complaint of radial nerve palsy.

"Then OP has not given any advice to do EMG test to find out the gravity of nerve palsy for giving further treatment or for doing surgery," observed the Commission.

Therefore, the Commission opined that this is a case where the doctrine of Res-Ipsa-Loquitur is applicable "considering giving of continuous same treatment (physiotherapy and splinting) even after knowing the complaint of radial nerve injury".

"The medical records itself shows the fact that 1st OP was negligent in giving proper treatment to the complainant by advising EMG test to ascertain the gravity of nerve palsy and to do nerve grafting or necessary treatment . Hence our opinion that no expert opinion from the side of complainant is not necessary," noted the Commission.

However, in respect of the other allegations that the complainant alleged that he lost his job due to disability of the hand, the Commission noted that there was no evidence regarding the percentage of disability. Meanwhile, the expert doctor and medical literature submitted by the doctors revealed that radial nerve palsy can be cured 100% if proper treatment were given.

"In this case, complainant could obtain treatment from other hospital than OP hospital by other doctors. So without any disability certificate, we cannot presume that complaint is suffering disability on his left hand due to the fracture happened. Hence our opinion is that complainant is entitled to get treatment expenses for the treatment availed at Specialists Hospital, Kochi because of the negligence on the part of OPs 1&2, in giving proper treatment after seeing Ext.A10 report, even though it is not proved that nerve palsy was happened due to the negligence on the part of OPs 1&2 in conducting surgery in a negligent way at 3rd OP hospital. Complainant is entitled to get compensation also for the mental and physical agony and for financial loss," opined the Consumer Court.

Therefore, the Consumer Court directed the doctors and the hospital to pay the expense of the second surgery i.e. Rs 1,87,514 and also directed them to pay Rs 2 lakh as compensation and Rs 25,000 as cost of legal proceedings.

"Opposite parties 1 to 3 are directed to comply the order jointly and severally within one month from the date of receipt of this order. Failing which Rs.187514/-+ Rs.2,00,000/- carries interest @7% per annum from the date of order till realization. Complainant can execute the order as per the provision in Consumer Protection Act 2019," it ordered.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/kannur-consumer-court-compensation-233572.pdf

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