5000 mcg dose of Trineurosol H intramuscular injection administered instead of 1000 mcg: Max hospital told to pay compensation

Written by Barsha Misra Published On 2022-05-17T11:30:02+05:30 | Updated On 17 May 2022 4:36 PM IST

5000 mcg dose of Trineurosol H intramuscular injection administered instead of 1000 mcg: Max hospital told to pay compensation

New Delhi: Holding the Delhi based Max Super Specialty Hospital guilty of negligence for administering wrong dosage of Trineurosol-H injection to a patient, the District Consumer Disputes Redressal Commission-II, New Delhi recently directed the Hospital to pay Rs. 20,000 as compensation to the complainant.

Such a decision was taken by the Commission as the Complainant alleged that the nurses in the OPD of the Hospital had wrongly administered high doses (5000 mcg) instead of 1000 mcg, which was originally prescribed.

Therefore, holding the Hospital guilty, the Commission directed, "Keeping in view all these facts, this Commission concludes that though OP1 has been negligent in providing service to the complainant, it would serve interest of justice by directing OP1 to be careful in future in providing proper care to their patients and OP1 is further directed to pay a sum of Rs. 20,000/- to the complainant for the mental harassment caused to him within a period of three months from the date of this order failing which OP 1 would be liable to pay interest @ 6%p.a from the date of the order till realization."

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The history of the case goes back to 2014 when the complainant was suffering from some problem regarding high homocysteine which he came to know because of a blood test. Detection of high levels of homocysteine has been linked to cardiovascular disease where a person is more prone to endothelial injury which leads to vascular inflammation, chronic renal failure, congestive heart failure, acute and chronic myeloid leukemia, polycythemia vera, carcinoma with liver metastasis, liver disease drug induced cholestasis and protein malnutrition.

When the complainant approached Delhi-based Max Super specialty Hospital and consulted Dr. Rahul Naithani, DM clinical haematology (AIIMS), the consultant doctor prescribed surgery clinical tests such as 1. Serum homocysteine 2. APTT 3. PT 4. D-Dimer 5.Vitamin B 12 and 6. Folate levels.

After examining the test reports Dr. Naithani prescribed the complainant Trineurosol- H intramuscular injection(1000 mcg) for next 7 days and thereafter once a week for 6 weeks. The complainant was also advised anti parietal cell antibody and anti intrinsic factor tests and thereafter he was advised to meet Dr. Shanti Swaroop, gastroenterologist.

Accordingly, the injections were bought and the complainant was administered the injections for 3 consecutive days on 5th, 6th and 7th March 2014 in the nursing OPD of the Max Hospital.

On the fourth day, the nursing OPD was closed and therefore the complainant approached the emergency care unit, where the nurse noticed that the complainant had been wrongly administered high doses (5000 mcg) as the vial was of 5000 mcg and not of 1000 mcg.

Thus, the contention of the complainant was that the nurses in the OPD negligently misread the instructions contained on the vial of the injection which had in clear terms indicated that the bottle contained 5 ml of the drugs and only one ml of the drug(1000 mcg) was to be administered.

He further argued that since the dose is administered to the complainant for 5 times the prescribed dosage, the complainant had irritation, nausea, tremors and other related complications including severe pain at the time of administration of the injection.

In fact, even on March 8, the emergency care unit of Max hospital administered further one ml of the dose when it was duly informed by the complainant about him having been administered 15,000 mcg of doses.

Therefore, the complainant approached the AIIMS trauma center and was advised for the test for Vitamin B12. The reports showed that Vitamin B12 was '1801' in one case as against the normal range of 187-1059 pg/ml.

As per the complainant the doctor at AIIMS trauma center expressed shock over the manner in which the complainant was handled and treated and given dosage of Vitamin B 12 without first analysing the root cause of deficiency of Vitamin B 12. It was argued by the complainant that B 12 can also be fatal, at times if not taken under medical supervision.

He alleged that he had to undergo severe trauma and he failed to focus on his work. Therefore, alleging medical negligence against Max Hospital, the complainant approached the Consumer Court and demanded an amount of Rs.10,25,000/- towards negligence, mental agony and harassment with 18% interest per annum and Costs.

On the other hand, denying any kind of negligence, the hospital submitted that the patient had a deficiency of Vitamin B 12 and therefore he had been advised to get injections of vitamin B 12 1000 mcg daily intramuscularly into 7 days and thereafter once a week for 6 weeks. Further denying the non-availability of the injection in the Hospital pharmacy, the authorities contended that the complainant purchased the set intramuscular injection from an unknown source and therefore its purity, originality and potency is not known and cannot be commented upon by the Hospital.

The Hospital also denied that the complainant mentioned about any irritation, nausea tremor or related complications including pain at the time of administration of injection.

It was further argued that presuming that any high dose of Trineurosol-H was administered to the complainant only a maximum of 15% is retained by the body and the higher dose is excreted out of the body immediately and even the 10-15% which is retained by the body is not harmful and eventually the result of the reading will come down. It was also submitted that Vitamin B 12 is a safe medicine and it is extremely rare for the patient to get nausea, vomiting and diarrhea.

Taking note of the submissions of both the parties, the consumer court noted that the hospital had not filed any document in support of their averment that the Pharmacy stocked injection Trineurosol-H. At this outset, the Commission noted, "Irrespective of the fact that the said injection was purchased from the pharmacy of OP 1 or from outside of OP1, it is the duty of the medical facility to take care to see what is being injected to a patient as also the quantity of injection."

In this regard, the Commission referred to the Supreme Court judgment in the case of Jacob Mathew vs. State of Punjab and Ors., where the court had held that "A professional may be held liable for negligence on one of the two findings: either he was not possessed of the requisite skill which he professed to have possessed, or, he did not exercise, with reasonable competence in the given case, the skill which he did possess."

However, the consumer court also noted that the complainant had not placed on record any document in proof of the averment that he either suffered from side effects of high dosage of the said injection of Trineurosol-H or he got treated for the same. In fact, the complainant had also not produced any expert opinion on it.

Thus, the Commission opined, "At most, it can be concluded that the complainant suffered mentally on account of having high dosage of Vitamin B12 as is evident from the reports of the laboratories filed on record."

To read the Commission order, click on the link below.

https://medicaldialogues.in/pdf_upload/max-hospital-176238.pdf

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Trineurosol- H intramuscular injectionMax Super Specialty Hospitalmax delhiDelhi consumer courtDistrict Consumer Dispute Redressal Commissionvitamin B12compensation

Barsha Misra

Barsha completed her Master's in English from the University of Burdwan, West Bengal in 2018. Having a knack for Journalism she joined Medical Dialogues back in 2020. She mainly covers news about medico legal cases, NMC/DCI updates, medical education issues including the latest updates about medical and dental colleges in India. She can be contacted at editorial@medicaldialogues.in.