IM Injection Causes Polyradiculopathy to Patient, Doctor told to pay Rs 4 lakh Compensation

The observation was made by the NCDRC president RK Agrawal and members SM Kantikar and Binoy Kumar after the Commission expressed its doubt regarding the prescription by the doctor made during the second visit.

Further, the NCDRC also referred to the medical literature relevant in the case, and holding the doctor guilty the Commission ordered him to pay Rs 4 lakh along with interest @6% per annum from the date of State Commission's order.

"In our considered view, the State Commission, after due consideration that the occurrence happened in 2000, awarded just and reasonable compensation of Rs.4,00,000/-. It is pertinent to note that we are now at the end of 2021, to meet the ends of justice, we deem it appropriate to direct the Petitioner to pay Rs.4,00,000/- with interest @ 6% per annum from 27.08.2014 i.e. from the pronouncement of the order of State Commission till its realization," read the order.

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The matter goes back to 2000, 21 years ago, when the patient, the complainant in the first case was taken by her father to the treating doctor with complaint of high grade fever. It was alleged that the treating doctor had administered one injection on her left buttock at a wrong site involving nerve.

Immediately after that, the patient experienced severe pain and developed swelling and became unable to stand or walk. Even though the doctor had assured that the pain would subside, when the pain persisted, the father of the patient took her to the doctor's clinic again. The doctor then had prescribed some medicines and had advised to consult a Neurosurgeon.

Thereafter the patient sought treatment at several hospitals but the pain didn't get better and when the patient's father contacted the treating doctor, it was alleged that the doctor didn't offer any help.

Therefore, being aggrieved, the patient and his father approached the District Forum.

On the other hand, it had been contended by the treating doctor that after administering the intra muscular injection Fevastin in the left gluteal region by disposal syringe, the patient initially hadn't suffered any pain or discomfort at the injected area.

Later when the patient came again with the complaint of pain in the buttock, it had happened as she had fallen on the ground. Considering the condition of the patient, he had prescribed anti-inflammatory drugs and had referred the patient to a Neurosurgeon, submitted the doctor and he further claimed that he hadn't charged any fee for the second visit.

After the District Forum had dismissed the complaint, the patient had approached the State Commission, which held the doctor guilty and had directed the doctor to pay Rs 4 lakh as compensation along with Rs 10,000 for costs.

Challenging the State Commission's order, the doctor approached the NCDRC. The counsel for the doctor submitted that there was no expert medical opinion for establishing medical negligence to prove that the nerve injury was due to wrong administration of injection.

Mentioning that the patient had a history of falling from the stool, the counsel for the doctor further submitted that the patient was treated by few other doctors and the pain was due to Spinal Cord problems.

After listening to the arguments by both the sides and perusing the medical record, the NCDRC also perused the order of the State Commission, which had noted that the prescription of the second visit had mentioned the words "NO INJECTION" within a square. The Commission had opined in its order that the doctor had voluntarily mentioned it in the prescription to cover his negligent act because there was complications in the injection during the first visit.

The State Commission had also observed that the root cause of all the problems was the doctor's negligence in pricking the injection needle at the wrong site inflicting damage to the nerve.

At this outset, the NCDRC bench noted, "We note the patient approached different doctors/specialist in Pondicherry, Chennai and Villupuram. We have carefully perused the prescriptions: issued by the few doctors. We note that initially patient had no neurological problem but after injection progressively she suffered poly-radiculopathy."

Further referring to the prescription of the second visit on 20.09.2000, the top consumer court observed, "At places some correction/interpolation are evident. We also note one entry on the left corner of the prescription (in the rectangular box) mentioned as but the purpose behind it is not clear. Such inscription on the prescription casts a shadow on the act of the Petitioner."

After perusing the entire medical record, the apex consumer court noted that the Government Hospital at Pondicherry had diagnosed the patient with Polyradiculopathy and the reports of MRI LS spine and MRI Dorsal spine were normal.

"Considering the entirety of this case, we are of the opinion that the final diagnosis Polyradiculopathy made at the institute cannot be faulted. Since September 2000, the patient was continuously suffering progressive pain in her left lower limb after the intramuscular injection in the left gluteal region. Thereafter, the patient took regular consultation with the Specialist in Orthopedic, Neurology etc. She approached JIPMER, the Department of Medicine, General Hospital at Pondicherry on 17.06.2003 and the diagnosis Polyradiculopathy was made, which is an uncommon peripheral nervous system syndrome manifested by symmetric / asymmetric distal and proximal weakness with varying sensory loss," noted NCDRC.

Referring to the standard surgical text books, the commission noted that "iatrogenic nerve injury has long been recognized as a common complication of Intramuscular (IM) injection. The buttock is a common injection site and the Sciatic nerve is the most commonly injured nerve following IM injection because of its large size."

"Although the incidence of Sciatic nerve injection injury (SNII) is less but it remains a persistent world-wide problem. The presentations of SNIIs may range from minor transient pain to severe sensory disturbance and motor loss with poor recovery," further noted the Commission.

Discussing the clinical findings related to SNII in detail, the NCDRC bench placed its reliance on Supreme Court judgment in the case of Dr. Laxman Balakrishna Joshi vs. Dr. Trimbak Bapu Godbole & Anr and A.S. Mittal vs. State of U.P. where the top court had discussed the duties that a doctor owes to a patient.

Upholding the State Commission's order, the top consumer court noted,

"In the case on hand, the Petitioner failed in his duty of care. The prescription dated 20.09.2000 creates doubt in our mind about the act of Petitioner. Based on the medical literature, the precedents and foregoing discussion, the negligence is determined against the Petitioner. In our considered view, the State Commission, after due consideration that the occurrence happened in 2000, awarded just and reasonable compensation of Rs.4,00,000/-. It is pertinent to note that we are now at the end of 2021, to meet the ends of justice, we deem it appropriate to direct the Petitioner to pay Rs.4,00,000/- with interest @ 6% per annum from 27.08.2014 i.e. from the pronouncement of the order of State Commission till its realization."

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