Failure in Diagnosing Neck Femur Fracture: Top Consumer Court Directs St Stephens Hospital to Pay Rs 5 Lakh Compensation

Setting aside the order of the State Commission, which had reduced the amount of compensation, the top consumer court took note of the fact that after the operation at the treating hospital, the complainant had to undergo surgery twice, which failed to permanently cure his physical condition.

"Considering the loss of earning capacity and future prospects, in our view, the compensation of Rs.5.0 lac is just and fair," noted R.K Agarwal, President of NCDRC, and Dr. S.M. Kantikar (member).

Also Read: Surgery with Blank Consent Form: Hospital told to pay Rs 1 lakh

The case concerned the patient who had suffered a road accident back in 2003 and sustained bodily injuries thereafter. After getting first-aid at a Government hospital, the patient was referred to the hospital where the treating doctor examined him and diagnosed him having a fracture of femur (thigh bone) on the right side.

Following this, the patient had undergone surgery and a rod was implanted from his loin to the thigh. During the follow-up treatment, a second doctor at the treating hospital examined the patient again and assured that it would take some more time for everything to get cured.

However, as the pain didn't get reduced and in May 2004, the complainant contacted another doctor who opined that there was a fracture of the loin bone, and advised the patient to approach the same hospital where he was first operated on.

Meanwhile, the family doctor of the complainant examined all the X-rays of the patient and opined that the fracture had occurred during the 1^st operation in the Operation Theatre (OT) of the treating hospital. When the patient again approached the hospital, he was advised for bone grafting as there was an unsatisfactory union of bones, for which the complainant didn't agree.

Again the complainant came back to the hospital with the complaint of pain in right hip and thigh. The X-ray revealed displaced intra-capsular fracture of neck femur and he was advised to undergo osteosynthesis- a valgus osteotomy and fixation with angled blade plate.

Unable to bear the cost of another operation, the complainant approached a Government Hospital for further treatment.

Thereafter, alleging medical negligence against the treating hospital, the complainant approached the District Forum and claimed a total amount of Rs. 16,97,800/- as compensation. The patient contended that X-ray taken before the operation didn't show any intra capsular fracture of neck femur. However, the X-ray taken after surgery within 24 hours, clearly revealed the intra capsular fracture neck femur.

Denying that the fracture of the loin bone had occurred during the surgery, the hospital submitted that the Complaint was false, misconceived and not maintainable. The hospital further submitted before the District Forum that the complainant was initially treated at a Government hospital, wherein the X-rays showed only fracture of femur shaft.

After hearing the contentions of both the parties, the District Forum partly allowed the complaint and directed the hospital to pay Rs 5 lac to the complainant along with Rs 5,000 as cost of litigation.

Dissatisfied with the directions of the District Forum, the treating hospital reached the State Commission, which modified the quantum of the award. The State Commission directed the hospital to pay a lump sum compensation of Rs. 2.5 lakh to the patient.

Thereafter, challenging the order, both the parties filed two separate applications before the NCDRC. The top consumer court listened to all the contentions of both the parties and perused the material on record, the Medical Record and the X-ray films.

After browsing through the medical literature related to the case, the Commission noted,

"As per the medical text; after stabilization of fracture of shaft femur due to stress iatrogenic fracture neck of femur may occur. Therefore, the presence of a sub-clinical occult fracture and failure to take necessary X-rays in external rotation of the shaft of femur may account for pre-operative mis-diagnosis."

Noting that the treating doctor had performed the operation for intramedullary nailing of shaft femur, the NCDRC bench observed,

"However, failure to take appropriate X-rays with external rotation of the shaft of the femur to rule out the presence of a sub-clinical occult fracture, may account for pre-operative mis-diagnosis. The pre-operative CT scan of the femur neck for all such patients was to be done before intra-medullary nailing of shaft fracture, i.e. closed nailing. The CT scan was to be repeated after closed nailing to confirm the condition of the femoral neck, unless a fracture was seen on a plain film or during intra-operative fluoroscopy."

"Having regard to the settled law that an error of judgment/failure to make diagnosis of a complicated condition by itself does not amount to negligence, but it can be said that missing fracture neck femur which normally is missed in 50% cases, is an act of negligence," the judgment mentioned.

Taking note of the fact that in 1/3^rd of cases of femoral neck fracture, the diagnosis is either delayed or missed, the Commission observed,

"Thus, it is essential to carefully evaluate the femoral neck in all patients sustaining high-energy femoral shaft fractures. Although there are a number of different implant options available for management of this challenging injury, most authors recommend that priority be given to anatomic reduction and optimal stabilization of the femoral neck fracture because nonunion, malunion, or avascular necrosis of this injury is more difficult to treat successfully."

"It is therefore important to understand that, especially in polytraumatized patient, present with femoral shaft fracture, the highest level of suspiciousness must be maintained for the concomitant presence of an ipsilateral femoral neck fracture," added the Commission.

Later, going through the medical record of the case, the Commission noted,

"the patient was evaluated with a pre-operative X-ray AP pelvis, which was negative. It was unclear whether a lateral view of the hip taken could have been more sensitive in detecting the femoral neck fracture. In our view the antero-posterior internal rotation hip X-ray if taken intra-operatively or immediately after the reduction of the femoral shaft fracture, could have helped in detecting the minimally displaced fracture of the femoral neck."

Noting that the complainant had established that the "delay/failure in diagnosis of fracture neck femur contributed to the unfavourable outcome," the Consumer Court ruled that "the treating doctor failed in the duty of care in the administration of treatment."

Referring to several judgments of the Apex Court which reiterated the principle of standard of care which is expected from a medical professional with a reasonable degree of skill and knowledge, the Commission disagreed with the view of the State Commission, which reduced the quantum of the compensation.

Upholding the judgment of the District Forum, the Commission noted,

"It is to note that after the treatment, subsequently, the Complainant underwent operation twice in Hedgewar Sansthan at Delhi but his physical condition did not improve. The doctors informed him about no possibility of complete cure in the future. He was the sole earning member in the family. The Complainant had been suffering since the year 2003 and we are now in 2021. Considering the loss of earning capacity and future prospects, in our view, the compensation of Rs.5.0 lac is just and fair."

Thus, the top consumer court directed the treating hospital to pay compensation of Rs.5 lac with interest @ 6% per annum from the date of filing of the Complaint and Rs. 25,000/- towards the cost of litigation within 4 weeks from the date of order, failing which the entire amount shall carry 10% interest till its realization.

To view the original judgment, click on the link below.