State Consumer Disputes Redressal Commission
Munni vs Institute Of Human Behaviour & Allied ... on 11 February, 2013
IN THE STATE COMMISSION:DELHI (Constituted under Section 9 of The Consumer Protection Act, 1986) Date of Decision: 11.02.2013 Complaint No -253/08 Smt. Munni Complainant W/o Shri Raj Singh, R/o C-1124, DDA Flats, Poorvi Loni Road, Shahdara, Delhi-110093. Versus The Head of the Department Opposite Party No.1 Institute of Human Behaviour & Allied Sciences, Dilshad Garden Shahdara, Delhi. Dr. Brijesh & Others Opposite Party No.2 Institute of Human Behaviour & Allied Sciences, Dilshad Garden, Shahdara, Delhi. CORAM Justice Barkat Ali Zaidi President Mr. S.A. Siddiqui Member(Judicial) 1.
Whether Reporters of local newspapers be allowed to see the judgment?
2. To be referred to the Reporter or not?
Mr. S.A. Siddiqui(Member Judicial)(Oral)
1. Smt. Munni has filed this complaint for a compensation of Rs. One crore against OPs for spoiling the life of her daughter by negligent treatment. It has been alleged in the complaint that on 12.7.08 she took her daughter Neeru a minor aged about 17 years to OP Institute of Human Behaviour and Allied Sciences(IHBAS), Dilshad Garden, Shahdara, Delhi for treatment as her daughter was suffering from fits continuously. The OP decided to conduct MRI test first. At the time of MRI test, the concerned doctors of the OP hospital gave two injections in the left hand of Neeru. No sooner the daughter of the complainant was given injections, the left hand had started getting blue and within moments, the whole of the left hand turned blue. There was swelling as well on the whole of the left hand. When the concerned doctors of the OP hospital saw that the condition of Neeru was becoming critical, they referred her to Guru Teg Bahadur Hospital(GTBH), Shahdara, Delhi, but the concerned doctors at GTBH in turn referred the case to the All India Institute of Medical Sciences(AIIMS), New Delhi. Till then, the condition of the Neeru worsened considerably and the doctors at the AIIMS again referred the case to Safdarjung Hospital. In Safdurjung Hospital, some test and examination were undertaken and it was found that the veins of the left hand of Neeru had been blocked. Injection has been administered by the concerned doctors of the hospital. There was swelling over the left hand including the fingers. The fingers started withering and ultimately all the four fingers of the left hand of the complainants daughter had to be amputated.
2. It was further alleged that before giving injection in the left hand bythe OP hospital, the left hand of the complainant daughter Neeru was alright. At the time of admission to the OP hospital Neeru was suffering only from the fits, but after administering the injections, the whole of left hand had turned blue and the fingers had been withered and ultimately four fingers of the left hand of Neeru had to be amputated. At that time, Neeru was just 17 years. Since four fingers of the left hand were amputated and she became permanently disabled person, her life had been spoiled. At that time she was studying in B.Com(Final) and was ace player of Judo winning several National Awards to her credit. Thus, the entire life of a young girl has been totally spoiled and no amount of compensation can be adequate for such unfortunate event in life. However, a complaint for awarding a modest compensation of Rs. One crore has been filed. It is also to be mentioned here that Smt. Munni, complainant, had lodged a complaint at PS Dilshad Garden, Shahdara on 3.8.08. against the OP hospital and its doctors for committing rash and negligent act resulting in amputation of four fingers of the left hand of Neeru. The complaint was filed on 10.12.08. It was admitted and notice was issued to the OP hospital.
3. It was stated that the entire allegations made in the complaint were totally baseless.
It was, however, admitted that patient named Neeru aged about 17 years was admitted in the Emergency Ward of the hospital on 12.7.08 between 3.00 to 3.30 p.m. with complaints of seizures and abnormal behaviour. The patient was referred to this hospital from Lok Nayak Hospital. Before Lok Nayak Hospital, she was admitted at Pushpanjali Hospital in Karkardooma, Delhi.
It was stated that prior to admitting the patient to IHBAS, she received treatment including intravenous injections for control of seizures and abnormal behaviour at other hospitals. In Sister Report Book relating to afternoon shift on 12.7.08 nursing staff of the OP hospital had made a noting to the effect that there was swelling and prick mark in the left hand and slight swelling in the right hand when the patient was brought to IHBAS emergency ward. Senior Resident(Neurology) on duty after examination of the patient, made diagnosis of shadow seizures with seizures and made her observation on the emergency card and instructed to administer injections namely lorazepam 4 mg IV in order to sedate the patient. She received injection lorazepam in the vein dorsam of right hand at 4.30 p.m. All precautions were taken to avoid giving injections in the left hand as there was already swelling in the left fore-arm and hand.
It was submitted that even after administering injection Lorazepam, patient continued her abnormal behaviour therefore Senior Resident(Neurology) was called to attend the patient. Patient was duly examined again. Since the p[patient did not sleep and continued her abnormal behaviour even after giving Lorazepam injection, injection haloperidol 10 mg and injection phenargan 50 mg intramuscular in glueteal region was given at 5 p.m. These things are clear from the hospital record maintained on the daily basis by nursing and other para-medical staff of the hospital. After this, the patient was sent for MRI(Brain) at 7 p.m. as per advice of the Senior Resident(Neurology) on duty. After MRI(Brain), her swelling was also attended too by applying thrmobophob ointment. Even after this, the patient continued to behave abnormally and therefore reference was made to DMO Psychiatry of IHBAS on 13.7.08 at 9.10 a.m. The patient was transferred to Psychiatry Department of the hospital for management of her abnormal behaviour. On examination by DMO Psychiatry, it was found that alongwith swelling in the left fore-arm and hand, cyanosis in left index finger was also there. As soon as cyanosis in left index finger was noticed, immediate referral was made to the emergency Surgery Department at Guru Tegh Bahadur Hospital at 10 a.m. on 13.7.08. The Surgeons on duty at GTBH diagnosis acute thomboembolic phenomena and advised to refer the patient to AIIMS for emergency vascular facility as this facility was not available at GTBH. It is noteworthy that facility of vascular surgery was also not available at IHBAS. Therefore patient was discharged from IHBAS and referred to AIIMS for further emergency management as advised by Surgeons at GTBH. It was further submitted that since the patient was behaving abnormally, appropriate drugs were administered and necessary injections were given at IHBAS.
However, those injections were not administered in the left hand as a matter of precaution as swelling was already noticed in the left hand.
4. It was denied that any wrong injection or treatment was given to the patient at IHBAS.
IHBAS took every precaution needed and proper treatment was given. The worsening of the condition of the left hand, fore-arm and fore-fingers cannot be attributed to IHBAS as alleged. Allegation of turning of left hand blue and amputation of fore fingers due to giving of wrong injections in the left hand are baseless. Therefore, no fault can be attributed to IHBAS, its doctors or para-medical staff. It was submitted that the cyanosis and subsequent complication in the left hand was the result of intravenous injection administered elsewhere. In the IHBAS, patient hardly stayed for two days and injections were given in the right hand glueteal region which did not cause any complication in left hand. It was denied that respondent institute and its doctors committed any rash and negligent act resulting in amputation of fore fingers.
5. The parties filed evidence in support of their case. Besides filing documentary evidence, the complainant also filed evidence by way of affidavit. Complainant also filed rejoinder and certified copies of the statements of four witnesses in criminal case No. 188/08 which have been taken on record.
Respondent/OP also filed evidence by way of affidavit alongwith copies of medical records(exht. R W1/1 (by collectively)
6. We have heard Shri Roop Ram Sajwal, advocate for the complainant and Shri S.D. Singh, advocate for OPs.
7. We have also perused the written argument filed on behalf of the complainant. It was argued on behalf of the complainant that at the time of hospitalization, complainant daughter Neeru was a young girl of 17 years and was a student of M.com. She was ace player of Judo and had won many National Awards. She had a bright and prosperous future. Since she started suffering continuously from fits, her mother tried her level best to get proper treatment so that her young daughter could be cured. She was admitted in the respondent/OPs hospital on 12.7.08. The left hand of Neeru was quite normal before giving injection but just after giving injections in the left hand by concerned doctors in OP hospital, left hand started turning blue and swelling also appeared alongwith bluishness and discoloration due to mistake committed in administering injection in OP hospital. All the veins of the left hand were blocked ultimately resulting in amputation of fore fingers of left hand at Safdarjung Hospital.
It was also argued that complainant has filed criminal case which is in progress in the court of ACMM, Shahdara, Delhi as criminal case No. 188/08. In this case statements of witnesses have been recorded and certified copies of the statements of the witnesses have been filed.
Dr. Chinta Mani(CW-2) from Safdarjung Hospital, Senior Surgeon stated that on 14.7.08 and 29.7.08, patient Neeru operated for compartment syndrome of the left upper ling and gangrene(date fingers) of the 2nd to 4th fingers at the proximal phenargal joint by faciotromy, compartment release and amputation of 2nd to 4th phenargal. There was an alleged history of receiving injections at IHBAS which could have probably contributed to this condition. CW-3 Dr. Lalit, Senior Resident, Department of Surgery, GTBH, Delhi when examined in the court as a witness, clearly stated that symptoms on the hand of patient may be due to the injections given in IHBAS and it could have probably contributed to this condition. From the statement of both doctors, it is clear beyond doubts that the doctors at respondent/OP hospital were careless and negligent to the extent of rashness and were directly responsible for the ultimate amputation of the four fingers of the left hand of Neeru.
It was further argued that in Emergency No. E.2008 of IHBAS, the concerned doctor has noted the alleged history of the patient in her own hand writing. There is no mention of any swelling or any mark of injection in the left hand of the patient in the noting of the doctor concerned and now to save their own skin, the respondent had concocted a false story that there was already swelling in the left fore arm and hand and that the injections given in the hospitals were in right hand, that full precaution was taken not to administer any injection in the left hand as there was already swelling in the left hand.
8. On the other hand, OP categorically denied that any injection was given in the left hand. Every precaution was taken and appropriate treatment was given. Worsening of condition of left hand cannot be attributed to IHBAS, as alleged. Cyanosis and subsequent complication in the left hand is the result of intravenous injection administered elsewhere. In IHBAS patient hardly stayed for two days and injections were given in right hand glueteal region which did not cause any complication in left hand. It was argued that complainant did not come with clean hands. Medicines were taken at private institute before coming to IHBAS patient was treated in Lok Nayak Hospital and Pushpanjali Hospital, Karkardooma. She was admitted in IHBAS on 12.07.08 at about 3.00 p.m. with the complaint of seizures and abnormal behaviour.
9. Doing MRI(Brain) is standard protocol for management/treatment of person with seizure disorder. The patient was given injection lorazepam, injection haloperidol and promethezine at IHBAS as prescribed in standard text books for treating patient of abnormal behaviour. Since patient continued having abnormal behaviour, necessary drugs were given and appropriate injections were administered.
10. Finally, it was argued that amputation of four fingers of Neeru was unfortunate but it was wrong to suggest that there was any negligence or rashness on the part of the respondent hospital, its doctors or staff.
There was no error committed much less an error which no doctor of reasonable competence will commit. Ruling of Honble Supreme Court in Martin F. DSouza vs Mohd. Ishfaq.was relied upon wherein the Honble Court has held that notice be issued to the concerned doctor only when an expert report from a doctor or committee is received that a prima facie case of negligence is made out.
11. Medical profession, though one of the noblest, is not immune from negligence which, at times, leads to physical impairments and sometimes even to death.
Due to technical nature of the problem consumers do not know what to do and therefore it is difficult to get relief.
12. Under law, initial burden of proof has been put on the complainant to prove the linkage between negligent act and damage. However, there are certain cases wherein complainant need not prove that and inference of negligence is drawn from the facts, circumstances and evidence of record and principle of Res ipsa Loquitor applies in full force. In a recent ruling Honble Supreme Court in V. Krishna Rao vs Nikhil Super Specialty Hospitalheld that where medical negligence is self-evident it requires no expert evidence to prove it. Held further thatwould become redundant.
13. In the present case, Km. Neeru was admitted in IHBAS on 12.07.08 at about 3.30 p.m. with complaint of seizure and abnormal behaviour. Before admitting her to IHBAS patient was treated in Pushpanjali Hospital, Karkardooma and then in Lok Nayak Hospital. Injection Lorazepam 4 mg IV was given to sedate the patient, but she continued with her abnormal behaviour and did not sleep. Injection haloperizol 10 mg and injection phenargan 50 mg intramuscular in glueteal region were given. Thrombophob ointment was applied for reducing swelling. MRI(Brain) was done before applying thrombophob. Patient continued with her abnormal behaviour. On 13.07.08 at 9.50 a.m. when patient was examined by DMO(Psychiatry), he found swelling in the left fore-arm and hand. He also found cyanosis in left index figure and the patient was immediately referred to GTB Hospital at 10.00 a.m. on 13.7.08. Now the important question arises whether cyanosis and subsequent complication in the left hand was the direct result of intravenous injection given by staff/doctors in IHBAS or elsewhere? It has been consistent case of the complainant and her daughter that doctors/para-medical staff at IHBAS was negligent in treatment of her daughter as a result of which four fingers of the left hand of Neeru had to be amputated. A Criminal Case No. 188/08 CW-2 Dr. Chintamani, Safdarjung Hospital, Senior Surgeon stated that on 14.07.08 and 29.07.08, patient Neeru operated for compartment syndrome of the left upper limb and gangrene(dead fingers) of the second to fourth fingers at the proximal phalyngal joint.
Fasciotomy, compartment release and amputation of second to fourth finger done. There was an alleged history of receiving injections at IHBAS hospital which could have probably contributed to this condition.
In the same case CW-3 Dr. Lalit, Senior Resident, Department of Surgery, GTB Hpspital, Delhi also stated that patient was referred from IHBAS hospital on 13.07.08(know case of seizure) with history of I.V injection(Lora) in left hand vein following that within half to an hour, patient developed swelling in left hand and gradual blacking and discoloration of hand.
On examination patient is conscious, pulse ninety per minute in right hand & in left hand radial not palpable, swelling in left hand present, cold, blueish discoloration present, capillary feeling increased with this a diagnosis of (query) acute thromboembolic phenomenon was made and patient was referred to G.B. Pant Hospital/Safdarjung Hospital/AIIMS department of vascular surgery for needful. Copy of MLC is EX CW3/A which bears my signature at the pt.A. The symptoms on the hand of patient may be due to the injections given in IHBAS hospital and it could have probably contributed to this condition.
Thus, the allegations of the complainant Munni or her daughter Neeru have found full and reliable support from two Surgeons of Safdarjung Hospital and GTB Hospital, Delhi and the complainant has been able to discharge her initial burden of proving her case from the facts, circumstances and evidence on record, we come to the conclusion that injection which was given in the IHBAS was intravenous but it was negligently given in artery and therefore swelling and other phenomena developed in the left hand fore-arm and fingers and ultimately led to imputation of four fingers of Neeru. On the basis of the above discussion, we also come to the conclusion that cyanosis and subsequent complication in the left hand was the direct result of intravenous injection given by doctors/staff of the IHBAS.
14. The amount of compensation has to be determined keeping in view the magnitude of the damage caused to the patient. It has come on record that Km. Neeru was a young girl of 17/18 years of age. She was a student of B.Com. and was also a Judo player having won many National Awards to her credit. She certainly had a bright future. Since four fingers of her left hand were amputated, her future life was spoiled and she had to live rest of her life as a permanently disabled person. It is difficult to determine compensation in monetary terms in such unfortunate cases. However, we are of the opinion that a sum of Rs. Five lakhs as compensation including cost of litigation would meet the ends of justice.
15. ORDER Complaint is partly allowed. OP No.1 Institute of Human Behaviour & Allied Sciences, Dilshad Garden, Shahdara, Delhi is directed to pay a sum of Rs. Five lacs as compensation to complainant Smt. Munni within period of two months from the date of receipt of the judgment/order. In case of default in payment, an interest @ 9% shall have to be paid from the date of order till the date of actual payment.
16. Copy of this order as per statutory requirements be forwarded to the parties free of charge and thereafter the file be consigned to Record Room.
(Justice Barkat Ali Zaidi) President (S.A. Siddiqui) Member(Judicial) ysc