Gangrene after IV negligence: Consumer Court slaps Rs 50 lakh compensation on hospital, doctors, Rs 28 lakh for bionic hand
Medical Negligence
Chandigarh: The District Consumer Disputes Redressal Commission (DCDRC) has directed a Chandigarh-based hospital and its three doctors to pay Rs 50 lakh compensation to a patient, who developed gangrene in her hand and had to undergo amputation while undergoing treatment for a gastrointestinal problem.
The District Consumer decided on the amount of compensation after noting that the patient will have to get a bionic hand and the treatment cost for the same will be around Rs 28,26,887.
"Hence, taking into account the totality of facts and circumstances, the present consumer complaint succeeds, the same is accordingly partly allowed and OP No.1 to 4 are jointly and severally directed to pay lump-sum compensation of Rs.50 lacs to the complainant within 45 days from the date of receipt of certified copy of this order failing which they are liable to pay interest @ 9% per annum on it from the date of order till the date of its actual realization," ordered the consumer court.
The history of the case goes back to 2020, when the patient/complainant, a resident of Mohali, was admitted to the Healing Hospital and Institute of Paramedical Sciences, Sector 34, with complaints of headache, vomiting, stomach-ache, and backache, and she was diagnosed with gastro problem. She was treated by Dr. Pal, the treating gastroenterologist, and was given medication orally and via IV; a Cannula was inserted in the left hand on the consultation of Dr Singhvi, the neuromedicine specialist.
Even though there was a minor improvement in the gastro issue, 3 days later, swelling and pain were reported in the left hand of the complainant, and the doctor allegedly assured the patient, saying that it was normal and would subside with time. However, by night, the pain increased instead of decreasing in severity. Dressing was done, and the Cannula was adjusted by the attending Doctors and staff. The next day, the patient's left hand turned blue and numb, and concern was raised immediately.
Dr. Pal and Dr. Bedi (Plastic Surgeon) took the complainant to the operation theratre and allegedly the family of the patient was not informed about the medical urgency of the situation. Doctors had informed the complainant that gangrene had developed and surgery was required urgently to avoid amputation of the arm.
Meanwhile, the doctors allegedly abandoned the surgery and referred the case to PGI Chandigarh. On this, the complainant and her family protested and objected to the incomplete treatment. Ultimately, the complainant was sent to PGI in an ambulance with an open wound, without stitches and proper dressing of the open wound.
It was submitted that on reaching the emergency ward of PGI, the doctors there treated the complainant (patient) by removing finger nails and referred the case to Vascular Surgeon who amputated four fingers of the patient and skin grafting was done at emergency at the PGI. Though complainant (patient) was discharged on 29.12.2020, she was under O.P.D. care of P.G.I. Consequently, the Medical Authority assessed the complainant's disability of 85% (Locomotor). It was submitted that being a housewife and left-handed, she can no longer perform her basic tasks and became dependent on family and a maid, further unable to write and perform banking or public documentation due to permanent loss of fingers.
Filing the consumer complaint, she demanded a total of Rs.1,51,76,887/- compensation for medical treatment, future treatment, pain and suffering, emotional distress, legal costs etc.
On the other hand, the hospital and the doctors submitted that since the patient was suffering from vomiting, treatment was started on IV, Antibiotics, PPIS, Antiemetics Painkillers by insertion of a Cannula on the left forearm. It was claimed that the patient was regularly monitored and her symptoms improved. However, two days later, swelling was observed on the patient's left hand and therefore, the Cannula was removed from the left forearm and was replaced with the right forearm.
They claimed that even though there was mild swelling on the left forearm of the patient, there was no discolouration and mind pain in it. On the night of 28.11.2020, the patient complained of pain in her left hand. There was tenderness but no cyanosis, and pulses present. She was advised Tramadol and Thrombophob ointment. However, severe serious symptoms were noticed on the morning of 28.11.2020 when there was severe pain and discolouration of skin was reported. Urgently, a Surgeon was called for surgery as there was swelling, bluish discolouration of skin of hand mottling. An emergency fasciotomy was recommended.
They claimed that the complainant and her husband were clearly informed about the seriousness of the condition of the patient and the risk of gangrene or amputation even after surgery. All steps were taken promptly and in accordance with standard medical protocols. The consent form for surgery was signed by the complainant herself. After shifting the complainant to operation theatre, surgery was commenced by the Surgeon, and it was noticed that the patient had tense compartments of the hand and forearm and muscles which turned dark in colour, superficial veins of the left hand and forearm were thrombosed, the artery was not palpable, and fasciotomy was performed; patient was shifted to the ICU, Heparin was injected into the patient, and blood was transfused.
Consequently, the patient was continuously monitored round the clock by the I.C.U. team and bluish discoloration were again noted on the fingers of the surgical site. Ultimately, she was referred to higher centre i.e. PGIMER, Chandigarh where a team of plastic Surgeons were available to deal with any kind of eventuality.
While considering the complaint, the consumer court noted that the patient was admitted to the hospital for gastro issues and was treated with IV medications. Cannula was inserted into her left hand and was left in place over multiple days. Further, the Commission noted that during the patient's admission in hospital, her hand turned swollen, blue and numb. Emergency surgery was attempted but aborted midway, and she was referred to P.G.I. Chandigarh was in the midst of surgery and referred to P.G.I. with an open wound. The Commission observed that photographic evidence and discharge summary were submitted in support of the fact that the patient's referral occurred in a critical, unstable condition.
The Consumer Court observed that the standard protocol for I.V. cannula management requires regular monitoring for signs of extravasation, infection and vascular compromise. The failure to remove the cannula despite swelling and pain led to the progression of Compartment Syndrome and Gangrene.
"As the condition of the patient worsened under the hospital care and emergency measures were delayed so it not only amounts to deficiency in service but also medical negligence of the OP No.1 to 4 because complainant when admitted had no problem of hand but gastro and her hand and arm was heal and healthy at the time of admission in the hospital. Amputation of four fingers of left hand happen due to insertion of cannula by hospital staff and thereafter developed pain and got swollen resulting in gangrene. When the patient went to hospital with heal and healthy left hand for gastro problem, Cannula was inserted by doctor/staff of hospital, latter developed pain and got swollen and got amputated due to development of gangrene while admitting in a hospital then burden of proof shifts to the hospital to prove that gangrene did not develop due to their deficiency and negligence which OP No.1 to 4 miserably failed to discharge. Further, the fact the hospital did not charge for the ambulance or remaining bills, as admitted by the complainant and not rebutted effectively, indicates implied acknowledgement of fault by OP No.1 to 4," the Commission observed at this outset.
"Taking into account documentary evidence including disability certificate of 85%, photographs, and R.T.I. response from P.G.I. Chandigarh substantiate the life-altering injury caused to the complainant/patient. The complainant being left handed and a homemaker, has clearly lost functionally and suffered physical as well as mental trauma which needs to be adequately compensated by OP No.1 to 4," it further noted.
The complainant's counsel informed the Commission about the Quotation of P&O International Pvt. Ltd., wherein the estimated price of I-Digit Access Bionic Hand is mentioned Rs.28,26,887/-. Taking note of the same, the consumer court directed the hospital and its three treating doctors to pay Rs 50 lakh as lumpsum compensation to the complainant.
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/dcdrc-chandigarh-df-ii-rs-50-l-compensation-302450.pdf
