State Consumer Disputes Redressal Commission
Dr. G. S. Yadav vs Halimaben Mohmadhusen Kala on 24 January, 2022
Details DD MM YY
Date of Judgment 24 01 2022
Date of filling 07 08 2014
Duration 17 05 07
BEFORE THE CONSUMER DISPUTES REDRESSAL COMMISSION,
GUJARAT STATE AT AHMEDABAD.
Court-3
APPEAL NO. 1148 of 2014 Dt: 24.01.2022
Dr. G. S. Yadav
Madhav Prasuti Gruh and Surgical
Hospital, Shapur Darwaja Road,
Near Limda Chawk,
Mangrol, Dist: Junagadh. ...Appellant
Vs.
Halimaben Mohmadhusen Kala
Near Nagda Bhammariya Kuwa,
Mangrol, Dist: Junagadh. ...Respondent
Appearance: Mr. A. O. Chudgar, Ld. Advocate for the Appellant
Mr. V. L. Hirpara, Ld. Advocate for the respondent
Coram: (Shri S. N. Vakil, Judicial Member)
(Smt. J. Y. Shukla, Member)
Order by Shri S. N. Vakil, Judicial Member
1. This Appeal is against medical negligence.
2. The Respondent - Halimaben Mohmadhusen Kala, filed Consumer Complaint No. 1 of 2014 with CDRF, Junagadh, against the appellant hereof - Dr. G. S. Yadav, alleging that she had uterus trouble on 06.11.2012, went for treatment with Dr. G.S.Yadav who adviced for curettage by operation and would be discharged within 4-5 hours of the operation. The opponent without making any investigation or obtaining any report, injected on her right hand and Dhindha whereby severe pain having occured in the hand it swelled and the figures stop working. Her hand also started stopping. Upon saying to the doctor, he checked her K.S.P A-14-1148 Page 1 of 31 hand and said that it is the effect of the injection and would relieve after applying ICE there. He discharged her at about 11 o‟clock in the night and she went home, but no difference was there in her swelling and also pain. The pain increased and continued throughout the whole night. Hence next day at about 9 o‟clock in the morning, she went to show him. He prescribed medicine and said that by medicine, it would be ok and go home and to come at about 4 o‟clock in the evening. Therefore she again went to the opponent at about 4 p.m. to show and said to him that the pain has increased and the hand has stopped working. Hence the doctor said that now he does not see and that she has to go to other doctor. He advised to go to Dr. Ajudiya of Kesod who examined her hand and advised to go to Rajkot or Ahmedabad immediately. Hence was immediately taken by her husband in ambulance to U.N.Mehta Hospital in the Ahmedabad, where doctor examined and said that trouble in hand has arisen by injection given by Dr. Yadav and would require operation of the hand. Even after the operation on 8.11.2012, her hand did not show any different nor started to work, therefore she was preferred to Surgical ward, Civil Hospital Ahmedabad, where doctor examined and said that the hand has stopped working because of side effect of the injection given by Dr. Yadav and that the hand above the elbow would have to be amputated. Hence she having not given consent, she went for treatment in Sifa Hospital Ahmedabad on 12.11.2012, where also doctor informed for the operation. She consented and her hand was operated. Yet her hand did not cure, the doctor advised for amputation from the right hand wrist and the doctor amputated twice from above the right hand wrist on 22.11.2012. Yet it there being no difference nor the hand started to work and the doctor having advised for amputation from above the elbow K.S.P A-14-1148 Page 2 of 31 which was done upon her consent. The doctor thereat informed her that the trouble she had in the right hand is because of the injection given by Dr. Yadav of Mangrol and hand amputed. Therefore, the injection that Dr. Yadav gave has been given without taking any care and carelessly has shown serious negligence in giving injection. Dr. Yadav also charged much more amount of costs towards themedical treatment. She had also incurred heavy costs for transportation, attendance charges and other, her life has become useless and is not able to do work as before. Her hand having amputated from the above 100% disability has occurred. She was earning Rs. 10,000/- per month from sewing and tailoring, which she lost. Life of her children have also become useless. She is not able to do her daily chores. Therefore, she claims Rs. 10 lakhs being 1 lakh towards mental pain, Rs. 3 lakhs towards medical treatment, Rs. 50,000/- towards transportation and special diet, Rs. 15,000/- towards attaining charges and Rs. 5 lakhs towards loss of future income, with 12% interest from the date of incident and Rs. 10,000/- towards costs.
3. The defence of the opponent vide written version is of total denial. On 6.11.2012 she came after dispensary hours at 9:15 p.m. with complaint of bleeding and informed that she had taken pills one or two days before to get miscarriage. Upon inspection it was observed that there was half abortion, which required curettage of uterus for which E & C procedure was required. She consented. The procedure requires Fortwin-1 C.C. and Phenergan-1 injections, to be given IV and were given thus. He injected in the vein in a normal way by locating the vein on elbow bend. It has not happened nor did she complaint about any severe pain by the injection. She fell into sedation by the effect of the injection and the uterus was cleaned successfully. She having appeared absolutely comfortable and in K.S.P A-14-1148 Page 3 of 31 two hours she having passed urine was discharged. Many times a green scar like congestion appears at the site of injection and pain there but it is bearable and normally cured by applying ice. She did not do any serious complaint till she was discharge in night of 6.11.2012. She came with a complaint of pain in the hand next day on 7.11.2012. Upon examination, there was some swelling in the elbow and below it. He being a gynecologist cannot treat such a complaint or surgeon‟s advise being necessary for such a complaint she was advised to go to the surgeon immediately and given her reference of Dr. Ajudia of Kesod, but during the time she goes to the surgeon he applied one injection and three tablets for relief in the pain. She did not go to any surgeon and came the same day in the evening and insisted for treatment by him saying that they have confidence in the opponent and she having been operated successfully therefore to treat her hand also. But the complaint being outside his scope, upon explaining, she and her relatives quarreled with him and went away, but did not take any treatment till night of 7.11.2012, and therefore for such reasons it was possible that there was more swelling and or complications in the hand. In such cases immediate treatment is necessary but she wasted more than 12 hours of time. He does not know what she did thereafter and whose treatment did she take. She gave complaint with Mangrol Police Station on or by 7.11.2012 to get him severely punished, not only to blackmailjim but also started campaign with the help of media and news paper. The police took statements of himself, and Dr. Ajudia wherein the complainant went only in the night of 7.11.2012, her had was swollen and for primary cause of law circulation of blood and was advised to go to the Rajkot or Ahmedabad. The police also took opinion of Civil surgeon, who clearly K.S.P A-14-1148 Page 4 of 31 opined that there was no negligence in treatment by him, from the details before the civil surgeon "accidental intra-arterial" injection seems to have been given was opined. The opinion was given from the discharge card and thus there being no negligence the police closed the file. First, she was admitted in U.N.Mehta Hospital Ahmedabad, on 8.11.2012 and discharged therefrom on 9.11.2012. During the treatment his arterial Doppler was taken on 8.11.2012. The report wereof showed "Impression:
normal right upper Limb Arterial Doppler Study" and had only swelling on external part of the hand till 8.11.2012 and there was no vascular injury, that is, as it has not happened that the injection came to be given in artery. The Doppler report proves it. According to the discharge card the Doppler test report showed only external swelling, only fasciotomy, that is fascia on the hand muscle is being opened and thereby the pressure gets released, (was performed). Thereafter again Doppler test was taken. The report whereof is that the blood was not going in ulner artery distal 1/3 and in redial 2/3. Under this situation infection of any type may occurr after the fasciotomy. It is pertinent to note that no culture sensitivity test was carried out in U.N.Mehta Hospital. Whereas this test done on 20.11.2012 showed resistance against antibiotics given. Considering this there is a possibility of infection during or after the fasciotomy. Venous Doppler tests was carried out on 8.11.2012 which report showed normal venous Doppler study of right upper limb, which first and second reports mean that the blood was going through the artery and returning from vein. Considering these 3 reports, her condition was not serious till 8.11.2012. According to discharge card after fasciotomy on 8.11.2012 and seeing all the 3 doppler reports she was discharged on 9.11.2012. The discharge card also mentioned "no K.S.P A-14-1148 Page 5 of 31 C.V.T.S. or cardiac treatment required" which means that no treatment of any vascular surgery or heart was required. Thus, till 9.11.2012 as per the opinion of doctors she had not only any vascular problem but was advised only regular dressing after post fasciotomy and certain oral medicines were prescribed. That is she was not required any specific treatment after 9.11.2012. It appears that on 9.11.2012 in the evening she first went as OPD patient in Ahmedabad Civil Hospital, there was infact no such reason to go there and as per the discharge card of U.N.Mehta Hospital she had to have regular dressing only. In Civil Hospital from OPD she was admitted as indoor patient, where her complaint is noted as there is blackening in figures of right hand. There in the hospital there was mention of facts with U.N.Mehta Hospital etc, and in reports of inspection there appeared swelling of right hand and blackening of right hand fingers and woulnd of fesciotomy. Her prothombing Time Test was carried out on 9.11.2012 which was normal and on 9.11.2012 she was given injection of heparing-5000 with other medicines, which is for opening block of thrombos. It means that the thrombosis was developed for some reason after the fesciotomy. Again doppler test was carried out in Civil Hospital on 9.11.2012, according to which after the fesciotomy wound, the blockage has occurred in the lower part of radial and alter artery of the hand. In fact in Doppler test with U.N.Mehta hospital, blood flow was shown normal in vein and artery. Whereas after the fesciotomy, in Doppler test of Civil Hospital, there is no blood flow both in artery and vein. Moreever it is seen "radial and lunar vein distal to wound cannot be evaluated due to probably vein is complex". In the present case the procedure, fasciotomy, which is being done, which is being done which ought to have been release the pressure, K.S.P A-14-1148 Page 6 of 31 has not been done at the site and the swelling having raised the vein and artery having been pressed, the damage has occurred thereto and thereby the blood flow has stopped. This situation is super added i.e. in addition if infection has occurred, the situation can become more serious. The hiperian injection that was given on 9.11.2012 was discontinued on 10.11.2012. But by the vascular surgeon, it was advised to be given again on 12.11.2012. It was given the next day. During the gap between the stoppage of injection and restarting the situation of blood circulation deteriorated more. Thereafter, she admitted in Shifa Hospital on 14.11.2012, without any reason, and probably she had discharged herself against medical advice of doctors in Civil Hospital. Thus, the complainant herself has wasted time. In this kind of cases when the injury deteriorates then the places wherefrom the damage has occurred has to be amputated immediately. Instead the complainant showed negligence and spoiled the case by treatments in different hospitals. There was no case of any amputation in U.N.Mehta hospital. There could have been treatment in Civil Hospital by some amputation. Considering the chain of events, such complication might have occurred by infection or some other way or there is possibility of complainants acting against the medical advice. In short, there was no such situation arose by his injection. There was no negligence of his part.
4. The CDRC, Junagadh by its judgment and order dated 9.07.2014, allowed the complaint and ordered the opponent doctor to pay total compensation of Rs. 7,50,000/- with 9% interest from the date of complaint i.e. 1.01.2014 and also Rs. 15,000/- towards costs of the complaint. It held that the complainant in her affidavit stated that because of the injection she had started severe pain in the hand and K.S.P A-14-1148 Page 7 of 31 swelling occurred in hand. The fingers of the hand stopped working and hand started stopping. Therefore, she complained to the doctor. The opponent has denied it. Had it been not true why the complainant would go to the opponent the next day at 9 in the morning to show her hand. It is not disputed that she went there having paining and swelling in the hand, and the doctor prescribed medicines and advised to come again in the evening. Her affidavit states that after the injection severe pain and swelling started in the hand and her fingers stopped working. Therefore, he believed the allegations in her affidavit to be true. On 7.11.2012, she again went to the doctor at 4 p.m. and the doctor advised her to go to surgeon and referred to Dr. Ajudia of Kesod. There is no reason to disbelieve the fact stated by her. Dr. Ajudia examined her and immediately asked her to go to Rajkot or Ahmedabad for treatment. This also shows that it is utterly true that after the injection unbearable pain occurred in her hand and developed swelling. In U.N.Mehta Hospital, the doctor stated that the trouble has arisen because of side effect of the injection and therefore operation is to be carried out. She consented and operation was carried out on 8.11.2012, but did not show any change.
Therefore, she shifted to Civil Hospital, Ahmedabad in surgical ward. There the doctor advised amputating her hand above the elbow. But she did not consent and admitted as indoor patient at Shifa Hospital for treatment. She was operated with her consent but did not cured, hence the doctor advised for amputation above the wrist. And it was amputated above the wrist which upon her consent was done on 22.11.2012. Yet the pain and swelling continued and was amputated from below the elbow. However, it did not restor hand in the working condition, and with her consent it was amputated from above the elbow. The opponent pleads K.S.P A-14-1148 Page 8 of 31 ignorance of facts, after is referred to Dr. Ajudia, but has disputed about the facts in her affidavit. Considering the above facts, it believe that the gangerene in right hand was for no reason other than the injection given by the doctor on right hand and for his negligence and carelessness. She was absolutely healthly, 25 years of age; normally gangerene would not occur by injection given for curettage, but only by the reason and carelessness and lack of care in applying the injection. The severe pain by the swelling were only for the reason of the injection given by the opponent in right hand. In discharge card of U.N.Mehta Institute of Cardiology and Research Center, mentions the case as that of "accidental intra arterial", the same was mentioned by Civil Surgeon of Junagadh in confidential letter to the Mangrol Police Station dated 15.06.2013, which in point No.5 stated that gangerene occurred by the injection given by Dr. G.S.Yadav. Cardiologist, Super Specialist of cardiology Department of B.J.Medical Collage, Ahmedabad, after inspecting the opinion in the discharge card stated that gangerene occurred for accidental intra arterial injection. Had the injection given in vein such a situation would not have arisen. It is not anyway lesser than medical negligence and carelessness, to give injection in arterial than vein. Considering her age as 25 years and trouble in daily chores, in bringing of children, changing cloths and would also loose income by sewing, she was doing, it granted Rs.5,00,000/- towards loss of right hand, Rs. 2,00,000/- towards costs of treatment, Rs. 1,18,178/- towards claim of Rs. 3,00,000/-, Rs. 50,000/- towards transportation and attendance charges, i.e. Rs. 7,50,000/- with 9% interest from the date of complaint, she having had to take treatment in Ahmedabad and also Rs. 15,000/- towards costs of the application.
K.S.P A-14-1148 Page 9 of 31
5. Being aggrieved by the same the opponent Dr. G.S.Yadav has preferred this appeal on ground, that the judgment is against evidence on record and without appreciating and properly considering the documents on record. He did not consider the opponent‟s written arguments at Ext.22, erred in interpreting the discharge summery card of U.N.Mehta Hospital, Institute of Cardiology and Research Center has erred in considering the history given by the complainant and recorded in the discharge card. Forum has ignored the fact that fasciotomy was done at Dr. U.N. Mehta Hospital and that according to Discharge Card, regular dressing was required to be done at the time of discharge . The Hon'ble District Forum has ignored the fact stated in the Discharge Card that no cardio - vasculary thorosis surgery is required. Therefore, it is submitted that according to the Discharge Card, there was no need for Vascular Thorosis Surgery in the case of the complainant. Forum has not properly considered the Radiology report no. D-2127 and 2139 dated 08/11/2012 produced at page No.258 and 260. According to this report, impression was normal right upper limb arterial Doppler study and normal Venus Doppler study of right upper limb. According to this report, there was no arterial thrombosis. Forum has posed itself as an expert and observed on page no.9 of the judgment that they believe that the gangerene caused on right hand of the complainant was the reason of administrating the injection negligently and that the right hand of the complainant was amputated. It is submitted that the medical expert opinion was not produced by the complainant in the Complaint No.01/2014 to the prove case of the complainant. Forum had ignored the opinion of Civil Surgeon, Junagadh, which was submitted by him to the Police Sub-Inspector, Mangrol, produced at page No.210. It is specifically stated by the Civil K.S.P A-14-1148 Page 10 of 31 Surgeon that there was "Accidental Intra-Arterial" while injecting intra- venus by the opponent. The Civil Surgeon had specifically replied the issue no.6 to the police inspector that there was no negligence on the part of Dr.G.S.Yadav in treating the patient. It is submitted that the opinion of civil surgeon at issue No.6 was ignored by the Hon'ble Dist. Forum. Forum has erred in forming its opinion without any support or reasoning that the injection was given in artery instead of vein in para No.7 on page No.10 (running page No.22) of the judgment. Forum has erred in considering the opinion letter of civil surgeon partly and failed to consider the entire independent document submitted by the Civil Surgeon, Junagadh. The Hon'ble District Forum has ignored the fact that „Accidental Intra-Arterial‟ is not considered negligence or deficiency of services on the part of opponent. Forum has misinterpreted opinion of Civil Surgeon though the Expert Opinion was given by the medical person. Forum has ignored that complication in the Doppler test after fasciotomy may cause due to any kind of Infection. The opponent had specifically made this statement in his reply and the same was not challenged by the complainant. The Hon'ble District Forum has ignored the Arguments of the opponent in which, this submission was made in writing. Forum has ignored the fact that there was no nexus between the administration of the injection by the opponent with the amputation of right hand of the complainant on 22/11/2012. Forum has ignored the fact that the treatment papers of „Shifa Hospital' were not produced before the Hon'ble Forum and no medical officers Civil Hospital, Shaif hospital and U.N. Mehta Hospital had filed the Affidavits regarding the treatment given at respective hospitals. Forum has ignored the fact that no doctor was examined nor Affidavit is filed of U.N. Mehta Hospital K.S.P A-14-1148 Page 11 of 31 regarding the alleged opinion that there was a difficulty and operation is necessary because of side effect of injection administered by the opponent. Forum has ignored the principles of assessment of compensation in case of amputation of the limb settled by the Hon'ble Supreme Court. It is submitted that there was no reasons assigned for arriving at compensation of Rs.5,00,000/- for loss of right hand of the complainant by the Hon'ble Forum. Forum has erred in awarding Rs.2,00,000/- for treatment expenses, Rs.50,000/- for attendant charges and Rs.15,000/- for costs of the complaint.
6. Heard Advocates Shri A. O. Chudgar, for the Appellant and Shri V. L. Hirpara, for the respondent.
7. The complainant - Halimaben Mohmadhusen Kala deposes by affidavit to the effect that she admitted for uterus clearance at Mangrol in opponent‟s hospital on 06.11.2012. The doctor without examining or getting reports injected on her right hand and Dhindha, whereby she had severe pain started in the right hand, it swelled, the fingers of the hand stopped working and hands started stopping. Therefore, she informed the doctor, the doctor said that it is by effect of the injection. It has occurred by the effect of the injection. Swelling would subside by applying ice and will be cured and also pain relieved. She was discharged at about the 11 in the night even after going home, there was no difference in swelling or pain. The pain severely increased, therefore in the morning at about 9, she went to his clinic, he examined and prescribed medicine and informed that by this it would be cured. But even at home there was no change in her swelling and pain, therefore at about 4 in the evening, she went to him. The doctor informed her that now, he does not conceive and that she had to go to other higher surgeon and advised her to go to Dr. K.S.P A-14-1148 Page 12 of 31 Ajudia of Kesod. Therefore she went to show to Dr. Ajudia, he examined her and advised her immediately to go to Rajkot or Ahmedabad. Her husband and she went in ambulance to U.N.Mehta Hospital, Ahmedabad for the treatment and admitted as indoor patient. The doctor there examined her and informed that it is by side-effect of the injection applied by Dr. Jadeja of Mangrol and therefore operation has to be done of the hand. Therefore, she consented and got operation of the hand on 8.11.2012. After this operation there was no difference in the hand and did not start working. Therefore, she was referred to surgeory department of Ahmedabad Civil Hospital. She admitted there, the doctor examined her and said that the Dr. Yadav of Mangrol had given injection in the hand by the side-effect of which this trouble has arisen. Hence, the hand would not cure and the right hand would have to be amputated from above the elbow. Therefore, she having not consented, went to Shifa Hospital, Ahemdabad for the treatment and admitted indoor patient on 12.11.2012. The doctor there also examined her hand and advised for operation. She having consented, the right hand was operated, however, it did not cure, the doctor advised for amputation from the wrist and amputed it from above the wrist on 22.11.2012. Yet there was no change in the hand nor was it working. The doctor advised for amputation from below the elbow. She having consented it was amputated from below the elbow. The hand did not work, therefore, the doctor advised for amputation from above the elbow. Therefore she having consented the doctor amputated it from above the elbow. Upon asking the doctor, he informed that her hand has stopped working because of the injection that Dr. Yadav gave in her hand and therefore it had to be amputated. The Dr. Yadav did not take any care at the time of giving injection or K.S.P A-14-1148 Page 13 of 31 render good service and applied the injection carelessly. And has thus shown deficiency in service. She is 25 years of age, disability has occurred to her main limb, the expenses were 3 lakhs, of which bills of Rs. 1,18,878/- are produced the rests having been lost, Rs. 50,000/- has been spent towards transportation and special food, Rs. 15,000/- towards attendance charges. She is also entitled to Rs. 1 lakhs towards mental pain. She is not in position to do her daily chores. It is a scheduled injury were total disability is 10%. She was doing sewing and embroidery work and earning Rs. 10,000/- a month. She has in all suffer a loss of Rs. 10 lakhs, which she claims from the opponent. Then, she deposes about the opinion given by civil surgeon, Junagadh to PSI Mangrol. The doctor at Ahmedabad and civil surgeon has opined that it has occurred because of injection given by Dr. Yadav and had therefore to be amputated. She was cross-examined by interrogatories. She denies that she had miscarriage or that it was because of the pills taken or therefore there was heavy bleeding. She was asked to go elsewhere as her condition was serious if wanted to, or that she was informed that there would not be any possibility to arrange for blood at Mangrol if required. She denies that Dr. Yadav obtained necessary laboratory report before D & C operation or that bleeding was for half abortion or that the spoilage remained in her uterus. It is true that doctor gave injection but it was wrong given, it is not true that doctor has said that fortvin-1, C.C. and Phenargon-1, C.C., IV injection were given wrong or that the injection was given in vein on elbow bend and answers that it was given below the elbow. She denies that at that time there was no pain nor did she complain. She denies that she did not complain of any pain or swelling on previous day before first complain in morning on 07.11.2012 only or K.S.P A-14-1148 Page 14 of 31 she was immediately advised to go to surgeon. It is not true that after the injection she went into sedation therefore the injection showed its effect and answers that she never went into sedation, yet she had trouble by the injection. She denies that the patient goes into sedation only if the injection is given in vein properly, or that the uterus operation was successfully completed or that when the injection is given in vein it is normal that at the site many a times there happens congestion or green scar or pain. She denies that she did not complaint of any pain by the injection till she was discharged from the hospital in the night. She denies that she went with the complaint on 7.11.2012, she was examined and asked to go to surgeon immediately or that till she goes to the surgeon, an injection and three tablets were given for interim relief or that she was told that it will be cured. She denies that she did not immediately go to the surgeon at Kesod even when asked to in the morning of 7.11.2012. It is true that she went to the opponent doctor in the evening on 7.11.2012 but denies that she wasted the whole day by then or that her husband and other insisted for treatment by the opponent. She denies that whole day of 7th was passed without treatment. She also denies that she was explained that in such cases immediate treatment should be taken. She has produced the statement and opinion taken by the police but does not know whether the police has filed the case after obtaining opinion of the experts. It is not true that civil surgeon obtained on 15.06.2013 that there was no negligence of the doctor. It is true that Dr. Yadav sent her to Dr. Ajudia on 06.11.2012, who has given police statement also but does not know whether he stated therein that the swelling was for low circulation of the blood. She admits that she admitted on 08.11.2012 in U.N.Mehta Hospital Ahmedabad and K.S.P A-14-1148 Page 15 of 31 discharged on 09.11.2012 and explained that she went away in a day because she was advised, from U.N.Mehta hospital and refused to Civil Hospital Ahmedabad, and denies that doctors at U.N.Mehta Hospital did not ask her to discharge but she left the hospital against medical advice. It is not true that no doctor from U.N.Mehta Hospital said that the trouble in the hand has occurred because of the injection given by Dr. Yadav. It is not true that arterial Doppler test was taken in U.N.Mehta Hospital on 08.11.2012 or that the report in the Doppler test is that the external swelling in the hand is normal and that there was no vascular injury noticed, or that her hand was working even when she was in U.N.Mehta Hospital. Operation was carried out in U.N.Mehta Hospital for getting her hand working. She does not know whether in U. N. Mehta hospital fasciotomy was carried out or not. To the question whether she knows that after fesciotomy, the blood artery would also close by infection namely Macrotizing Fasciatis, she answers that the hands stopped working before she was admitted in U.N.Mehta Hospital. To the question that condition of hand may deteriorate by any injection after fesciotomy, she answers that condition of the hand had spoiled before she was admitted in U.N.Mehta Hospital. She denies that there was report that she is resistance to almost antibiotics. She denies the question that first Doppler venus Doppler test was normal on 8.11.2012 and that there was circulation of the blood or that there was no any serious condition looking to the report dated 8.11.2012. It is not true that doctors at U.N.Mehta hospital did not say of gangrene or any other complications to have occurred and that therefore only the doctors performed fasciotomy. To the question that there would not have been necessity to ampute, had proper treatment taken as per the advice of K.S.P A-14-1148 Page 16 of 31 doctors in U.N.Mehta Hospital, she denies it and answers that she was from the beginning advised for amputation. (55). She denies that swelling would have subsided and hand cured by the operation of fasciotomy. To the question that in the discharge card of U.N.mehta, it was also mentioned that there is no necessity of vascular surgery or heart treatment, she denies it and answers that as per the opinion in the discharge card, the gangrene is mentioned to have occurred by accidental intra-arterial injection, while giving intra venus injection. She denies that it is mentioned that after the fasciotomy operation there was no further treatment required than, regular dressing and oral medicine. She admitted in Civil Hospital because she was referred to by doctor of U.N.Mehta Hospital. It is not true that her Prothombing tests was normal on 9.11.2012 or that the injection given was for opening the block or that Prothoimbing occurred after the fasciotomy. She denies that infection may be the cause of failure of fasciotomy operation or its failure to give desired result. It is not true that condition of blood circulation deteriorated because of stoppage on 10.11.2012 of Hyperin Injection given on 09.11.2012 which was again given on 12.11.2012. She denies that she left Civil Hospital on 14.11.2012 against medical advice, and answers that she went from Civil Hospital to Shifa Hospital least her hand cures by treatment from other doctors than amputated. She denies that the injury more deteriorated because she wasted more time after discharge from U.N.Mehta Hospital or that no proper decisions were taken from treatment from U.N.Mehta Hospital till Shifa Hospital and there was no proper treatment. She denies that she had no proper and timely treatment in Civil Hospital or the U.N.Mehta Hospital or that she acted against advise of doctor in every hospital or that her hand was not K.S.P A-14-1148 Page 17 of 31 advised to be amputated from above the elbow in Civil Hospital (73) or that she denied for operation and also wasted time in Shifa Hospital, or that it was not amputated from above the wrist on 22.11.2012. She denies categorically every allegations of the examination in chief and also denies that artificial hand can be affixed and answers that it having been amputated from above the elbow, artificial hand cannot be fitted.
8. The opponent Dr. Gaganbihari Shantilal Yadav, deposes by affidavit that for the procedure involved first fortwin-1 C.C. and Phenargan-1 C.C., IV injection are to be given, intra venus and were given that way after locating vein on elbow bend. It has not happened the complainant to have any excessive pain by injection, nor did she complain. After the injection she came under the effect of sedation uterus was cleaned and after 2 hours urine having passed and she appeared to be absolutely fit, was permitted to go home. Many a times in case of IV injection there occurs conjestion like green scar on the site, but pain is bearable and relieved normally by applying ice thereon. Till she was discharged on 06.11.2012 in the night she did not complain anything. She came next day on 7.11.2021 and complained about pain in the hand. Upon examination she had some swelling on elbow and below it. Being guinac and cannot do such kind of treatment, advised her to go to the surgeon immediately and gave her name of Dr. Ajudia of Kesod. But for interim relief and prevention of the pain till she goes to the surgeon he gave one injection and three tablets. She did not go to any surgeon thereby and came to me in the evening again and insisted for treatment through me saying that they have confidence in me. But her complaint not being in my scope upon explaining they quarreled but did not take any treatment from morning till night of 7.11.2012. And for such reasons it was K.S.P A-14-1148 Page 18 of 31 possible that more swelling and such complications would have occurred. In this kind of cases, immediate treatment becomes necessary but she wasted more than 12 hours of time. He does not know what did she do thereafter or whose treatment she took. In police statement Dr. ajudia of Kesod was taken wherein the complainant went to him in only the night on 7.11.2012, upon examination her hand was swollen and primarily low circulation of blood was observed and advised to go Rajkot or Ahmedabad. The police also took opinion of civil surgeon wherein he has stated that there is no negligence in his treatment and gave opinion upon discharge card that accidental intra-arterial injection appeared to have been given. Thus, no negligence having been found the police filed the case. Considering the papers submitted by the complainant before police, it appears the condition emerges: "she was first admitted in U.N.Mehta Hospital Ahmedabad on 8.11.2012 and discharged on 9.11.2021; during treatment arterial Doppler test was taken on 8.11.2021, the report whereof mentions „impression: normal right upper limb arterial Doppler study‟, till 8.11.2012 she had only external swelling and had no vascular injury by the injection given i.e. to say it has not happened that injection was given in the artery. It is proved from this Doppler test report. (page 252 para-8). However, it appears from the discharge card that only external swelling having been found, the pressure from fascia of the muscle gets relieved by fasciotomy. Whatever has happened might have happened after this fasciotomy, but upon re-doppler test, report is that the blood is not approaching in ulner artery distal 1/3 and in radial 2/3. It means that the blood was not approaching in radial upto 2/3 and in ulner upto 1/3. Such a situation may arise if infection occurs after fasciotomy. There was no any culture sensitivity test till she remained K.S.P A-14-1148 Page 19 of 31 U.N.Mehta Hospital. It was done on 20.11.2012. Resistance against antibiotics till that date. Complaining it there is a probability of infection during or after the fasciotomy. On 8.11.2012 venus Doppler test was carried out wherein appears normal venus Doppler study of right upper limb which means that according to first report, the blood was passing through artery and returning from vein according to venus Doppler. Considering these 3 reports, till 8.11.2012 there was no serious condition. She was discharged on 9.11.2012 after fasciotomy on 8.11.2012 and seeing all the three Doppler test reports. In this discharge card it was also mentioned "no CUTS and Cardiac Treatment required"
which means that the complainant did not required CUTS i.e. treatment of vascular surgery or relating to heart. Thus, according to opinion of the expert doctor, she had no vascular problem till 9.11.2012 and only that post fasciotomy, she was discharged with advise for regular dressing and oral medicine. That is to say after 9.11.2012, there was no any more treatment required. In fact, there was no reason for her to first go as OPD patient in Civil Hospital on 9.11.2012 in the evening. She was only required as per discharge card of U.N.Mehta Hospital to get regular dressing. While admitting as indoor patient in Civil Hospital, her complaint is noted of blackening in the right hand fingers. While taking history, mentioning the facts about U.N.Mehta Hospital and her reports of swelling in upper of right hand, blackening of fingers in right hand and of fasciotomy wound were noted. Prothombing test done on 9.11.2012 was normal. For thrombuses i.e. opponening block, heparin 500 along with other medicine was given on 9.11.2012. It means that thrombuses can be believed to have developed for any reason after fasciotomy. Doppler test was again taken in Civil Hospital on 9.11.2012, according to K.S.P A-14-1148 Page 20 of 31 which after the fasciotomy wound there developer radial and ulner artery block in the lower part of the hand. In fact in the Doppler test in U.N.Mehta Hospital vein and artery blood flow were shown normal, whereas after fasciotomy in Doppler test in Civil Hospital, there is no flow in ulner and radial artery and both veins. In addition, it is observed that "radial and ulner vein distal to wound cannot be evaluated due to probably vein is close". It shows that the pressure was not relived from the site after the fasciotomy and swelling having increased the vein and artery compressed, damage has occurred and blood flow has stopped. This situation is super added that is, may become more serious if there is infection. As per instruction of vascular surgeon, the heparin injection which was given on 9.11.2012 was stopped on 10.11.2012, and was again given the next day. During the gap between stoppage and reapplying heparin injection situation of blood circular further deteriorated. She probably discharged from Civil Hospital against medical advise and admitted in Shifa Hospital on 14.11.2012. Thus, the complainant herself has wasted time and in such cases when the injury is getting worst, it has to be immediately amputated therefrom. The complainant has instead shown carelessness and spoiled her case by taking treatment from different hospitals. There was no any case of any amputation in U.N.Mehta Hospital and treatment could have been by some amputation in Civil Hospital. Considering this series of events, the complications might have occurred by infection at any stage or it is possible that by her acting against medical advice. In short, no such condition has arisen by opponents injection and there was no negligence on his part. The complainant has suppressed many facts in complaint and affidavit. She has also suppressed the reason for curatage. Then he K.S.P A-14-1148 Page 21 of 31 denies the allegations in her affidavit and examination. No such injury has occurred by any his injection. It is pertinent to note that she does not admit the fact of anesthesia given and her going in sedation. He points out that she denies Doppler test in U.N.Mehta Hospital, evasively answers about fasciotomy. She was resistance to any antibiotics, there was no any serious condition as report on 8.11.2012 of first Doppler venus was normal. There were no symptoms of any gangrene. The Prothombing time test dated 9.11.2012 was normal. In cross- examination by interrogatories, he answers that it was necessary for curettage. He denies that no consent was taken prior to the operation and answers that she had applied in his presence her impression of right hand and her relative Mohmadhusen Kala also signed in his presence. In every case what reports are required depends upon the condition of the patient and the procedure to be carried out. He denies that no reports were taken before the procedure and answers that he obtained reports of Hemogram and Sirology, that were necessary. He admits that there is no M.D.Pethology Laboratory Technician available at Mangrol. The reports were obtained from P.G.DMLT. He does not know or say whether report of DMLT Laboratory Technician is recognized by medical counsel or not. He denies that the operation was carried out without any report. The operation did not fail. At Mangrol, there is no Anesthesis, it was not necessary to call any anesthesia doctor in this case. In case of G.A. or Spinal Anesthesia, the Anesthetist has to remain present but in this case there was no G.A. or Spinal Anesthesia. It is true that before the operation, applied injection in Dhindha and right hand vein, it is not wholly true that before the operation he told to the complainant that it would be immediately cured and discharged. The injection that was given K.S.P A-14-1148 Page 22 of 31 in vein was for sedation and it gave effect. Upon her falling in sedation her operation was carried out. It is not true that upon giving it, in right hand immediately severe pain started, or after the injection her hand swelled more. He denies that after the operation severe pain continued of which she complained and having answered that swelling would subside by applying ice on swelling. And explains that in many cases of IV and IM if the patient stiffens the part or shifts and there would be green scar in which case it is normal to advise to apply ice but in this case no such thing has happened. It is not wholly true that he instructed upon discharge to come again in the morning if there is any trouble, and answers that she was advised to come for follow-up after 7 days. He denies that the complainant came because she had more trouble in the hand or the swelling did not subside, and answers that when she was discharge she did not complain of any pain or swelling in the hand but for the first time she said that had pain in the hand for the coming first time morning on 7.11.2012. Upon examination swelling was observed and was therefore advised to immediate go to Kesod for advise of the surgeon. He denies that he gave treatment for pain on 7.11.2012 and advised to go home saying that it would be cured and answers that she was asked to go immediate to the surgeon but upon her husband getting wild and saying that he only has to give medicine, he immediately gave injection and prescribed medicine but advise to go to surgeon immediately. To the question that complainant hand having stopped working and more trouble having arisen, the complainant came for treatment on 7.11.2012 after the noon, he denies that her hand having stopped working. On 7.11.2012 the complainant came late in the evening and wasted the whole day without going to the surgeon. He also denies K.S.P A-14-1148 Page 23 of 31 that to have said that he does not conceive and to go to Dr. Ajudia of Kesod and answers that in the morning of 7.11.2012 only he advised to go to the surgeon. On 7.11.2012 in the evening also they came and quarreled when he said that he cannot do such kind of treatment. He does not know whether the complainant immediately went to Dr. Ajudia in Kesod who advised to go to Rajkot or Ahmedabad, or that when she went to Dr. Ajudia also there was swelling in the hand and blood circulation had stopped, or the complainant immediately went from Kesod to Ahmedabad at U.N.Mehta Hospital for the treatment and took treatment as indoor patient, or not. The doctor of U.N.Mehta Hospital admitted her on 8.11.2012. He denies that in the discharge card of U.N.Mehta Hospital gangrene is mentioned to have been occurred due to accidental intra arterial injection and answers that in fact on the second page of discharge card the complainant history is written and therein only possibility is shown and nothing is mentioned about gangrene. On the contrary compartmental syndrome is diagnosed and treated with fasciotomy. If there is gangrene fasciotomy cannot be done but gengerious part has to be removed. Whereas in the present case after fasciotomy she was discharged on 9.11.2012 with advice only for dressing hence there were no symptoms of gangrene till 9.11.2012. It is clearly mentioned in opinion of 15.06.2013 that there is no negligence on his part. He denies to have shown any negligence or deficiency in service. He denies that it has emerged from police papers that the gangrene occurred because of the injection and answers that police has demanded summery. He does not know whether the doctor of Ahmedabad Civil Hospital also suggested amputation from above the elbow or that because she got afraid of amputation went to Shifa Hospital at Ahmedabad for K.S.P A-14-1148 Page 24 of 31 treatment and answers that by this time wasted therein the complications can occurre. He does not know whether doctor at Shifa Hospital also advised for amputation of the right hand. He does not know whether at Shifa Hospital first her hand was amputated from the wrist, and answers that it raises doubt when she in the interrogatory first says that in the Shifa Hospital the amputation was done from the wrist, whereas in the Civil Hospital the doctor advised for amputation from the elbow in question. He does not whether the hand was amputated below the elbow when it did not cure. Then he shows ignorance where and when the amputation from which part was advised. He denies that the doctors at U.N.Mehta Hospital, Civil Hospital and Shifa Hospital mentioned the gangrene to have occurred by the injection and answers that there is no such direct proof or certificate, in fact the complainant has wasted time from 7.11.2012. However, when fasciotomy was done in U.N.Mehta Hospital there was no gangrene. Thereafter when if any complication might have occurred during the time she was visiting Civil Hospital and thereafter Shifa Hospital, then the liability thereof would be of the doctors treating after 7.11.2012 or it might have occurred or there might be possibility of it to have occurred for the negligence of the complainant. But so called amputation cannot be connected with the injection. He denies complication after his operation. There was no serious condition till discharge card dated 9.11.2012. For the situation as on 7.11.2012 it has been mentioned that no treatment of specific vascular surgeon was required and only dressing from the fasciotomy and oral tablets were prescribed. It shows that she had no serious condition till 9.11.2012. Civil surgeon has clearly opined that there was no negligence on his part. Rests of the deposition is of denial. The K.S.P A-14-1148 Page 25 of 31 Doppler test with U.N.Mehta Hospital clarifies that blood circulation was continuing, the Doppler tests before fasciotomy also showed circulation to be proper. She had only swelling and therefore there was no question of any amputation or gangrene.
9. The appellant has submitted write-up from Kings Collage Hospital Titled "Compartment Syndrome and Fasciotomy", to the effect that: The main symptom of compartment syndrome is pain. Pain usually occurs even at rest and may be worse on movement. Pain is likely to occur after surgery, however in compartment syndrome the pain tends to be serve and out of proportion to the injury. Nerve damage may also make the pain worse, resulting in a burning sensation around the area. Pins and needles can also occur in the limb affected and you may have numbness when the skin is touched. An affected limb may also be pale, cold and feel tense and hard. As compartment syndrome progresses you may experience reduced strength and movement in the affected limb. Complications can include: permanent nerve damage, permanent muscle damage and reduced function of the affected limb, permanent scarring due to the fasciotomy procedure on the affected limb, in rare cases, loss of the affected limb, infection, kidney failure: as muscle dies various chemicals are released that can damage the kidneys, in rare cases death can occur. Compartment syndrome should be treated as quickly as possible to reduce the likelihood of permanent nerve and muscle damage. The aim of treatment for compartment syndrome is to relieve the pressure within the fascial compartment surrounding the muscles. This is done by performing an operation called a fasciotomy. In a fasciotomy, the skin and fascial compartment are cut open so that the compartment pressure is relieved. Any dead muscle will be removed at the same time. The K.S.P A-14-1148 Page 26 of 31 wound is usually left open to prevent the pressure from building up again. The wound may be closed using stitches some days later Sometimes skin grafting is used to close the wound or the wound is left to heal by itself. Sometimes a fasciolomy will be performed to prevent compartment syndrome occurring if you are considered at high risk of developing it.
10. He maintains that he applied injections in vein; denies of having applied in artery. Now, cause precedes effect here, a compartment syndrome which requires fasciotomy. He explains that in many cases of IV and IM if the patients stiffens the part or moves it and there would be a green scar in which case it is normal to advise to apply ice, but in this case no such things has happened. Therefore, this factum of fasciotomy, in absence of any else, clearly proves that injection was applied in vein. He applied two injections, hence factum of her going into sedition is no answer to displace the above finding. Applying injection in artery than vein is a negligent act when viewed in light of serious effects it brings about. Hence, the fact, that doctor opined before the police that it was accidental intra-arterial injection, and that the opponent is not negligent, and the case was closed, is not found to be helping the opponent against the judicial finding.
11. There is nothing to show that he verified that it has gone into vein only, by drawing little back plunger which, if it is in artery would without any effort fill the syringe with blood. He did not do so as is proved by the fact that he allowed her to go home, that too with advise to apply ice only, and to come for follow up after 7 days as he deposed. This speaks of his negligence. Next day also when she came, he asked them to go to Dr. Ajudia immediately, but did not at all said anything that it may, if time is K.S.P A-14-1148 Page 27 of 31 allowed to pass, cost her limb also. This adds to his negligence. In his deposition he does not depose that she was explained that in such cases immediate treatment should be taken, when she denied this suggestion in her cross-examination. Hence it remains that he did not explain that in such cases immediate treatment should be taken.
12. She went to Dr. Ajudia on 7th. On 8th went to U.N.Mehta Hospital, the discharge card thereof reads „C/o blackening of Rt hand fingers and swelling in Rt. Forearm X(1) day‟. Then succeeds fasciotomy there. Hence blackening of fingers having already been there, clearly negative the defence that fasciotomy brought about the situation. Even the fasciotomy was unable to cure.
13. Her hand stopped working. Fingers blackened. After the fasciotomy, her hand was first amputed from wrist, then from below the elbow, and then from above the elbow. There is nothing to establish that there was, during or following the fasciotomy, infection. These therefore pale all:
that Doppler tests report show "impression: normal right upper limb arterial Doppler study"; on 8.11.2021 that she had only external swelling and had no vascular injury by injection given; that from discharge card only external swelling having found, the pressure from fascia of the muscle gets relieved by fasciotomy and whatever has happened might have happened after this fasciotomy, but upon re-doppler test, report is that the blood was not approaching in ulner artery distal 1/3 and in radial 2/3, means that the blood was not approaching in radial upto 2/3 and in ulner upto 1/3; that such a situation may arise if infection occurs after fasciotomy; that no any culture sensitivity test till she remained in U.N.Mehta Hospital was made, which was done only on 20.11.2012; that she had Resistance against antibiotics till that date; that considering it K.S.P A-14-1148 Page 28 of 31 there is a probability of infection during or after the fasciotomy; that according to first Doppler report, the blood was passing through artery and returning from vein; that considering these 3 reports, till 8.11.2012 there was no serious condition; that there was "no CUTS and Cardiac Treatment required" meaning that the complainant did not require treatment of vascular surgery or relating to heart; after the fasciotomy was done, that she had no vascular problem till 9.11.2012 and only that post fasciotomy, she was discharged with advise for regular dressing and oral medicine, requiring no more treatment after 9.11.2012; that there was no reason for her to first go as OPD patient in Civil Hospital on 9.11.2012 in the evening; that her Prothombing test done on 9.11.2012 was normal; that heparin 500 along with other medicine was given on 9.11.2012, which goes to show that thrombuses can be believed to have developed for any reason after fasciotomy; that according to doppler test taken in Civil Hospital after the fasciotomy wound there developer radial and ulner artery block in the lower part of the hand; that pressure was not relived from the site after the fasciotomy and swelling having increased the vein and artery compressed, damage has occurred and blood flow has stopped; that during the gap between stoppage and reapplying heparin injection situation of blood circular further deteriorated; that she discharged against medical advise and admitted in Shifa Hospital on 14.11.2012; that the complainant herself has wasted time; that she instead shown carelessness and spoiled her case by taking treatment from different hospitals; that there was no any case of any amputation in U.N.Mehta Hospital and treatment could have been by some amputation in Civil Hospital. Now, the fasciotomy did not cure and therefore the amputations were required. It is but natural that anyone K.S.P A-14-1148 Page 29 of 31 would go for second opinion so as to see if amputation could be avoided.
This cannot be taken as any contributing to any negligence on the part of the complainant.
14. The opponent, for aforesaid reason, is clearly found negligent. He is not entitled to any concession for faults, if any, of other doctors as against his liability towards the complainant. He may have to follow the other doctors for contribution.
15. She was 25 years, to be taken to falling within age group of 25-30 years, attracting multiplier of 17. Her earning may even notionally be taken at least Rs. 3,000 a month. Right arm amputed from above the elbow has 80% disability for body as a whole, under the schedule to Workman Compensation Act. This brings about loss of future income itself to Rs. 4,89,600/-. To this are required to add others towards loss of current income, expenses, attendant charges, transportation, special diet, pain, shock, suffering etc. Therefore the compensation of Rs. 7,50,000/- as awarded by the Ld. Forum cannot be taken on higher side but just only.
16. For the reasons stated, the judgment and order of the Ld. Forum cannot be assailed, but confirmed, with dismissal of this appeal for which following final order is passed.
FINAL ORDER
i) Appeal No. 1148 of 2014 is dismissed.
ii) No order as to costs.
iii) Registry is directed to pay the deposited amount, with accrued interest, if any, on proper verification to the appellant by account payee cheque and the cheque be handed over to the advocate for the appellant after obtaining receipt.
K.S.P A-14-1148 Page 30 of 31
iv) Registry is directed to send a copy this order to the District Commission Junagadh, through E-mail in PDF format for taking necessary action.
v) Copy of the judgment be provided to the parties free of charge.
Pronounced in the open Court today on 24th day of January, 2022.
(J.Y.Shukla) (S.N.Vakil)
Member Judicial Member
K.S.P A-14-1148 Page 31 of 31