BEFORE THE A.P.STATE CONSUMER DISPUTES REDRESSAL COMMISSION:HYDERABAD
F.A.No.90/2005 AGAINST C.D.No.104/2003, DISTRICT CONSUMER FORUM-II, KRISHNA AT VIJAYAWADA
Between:
Dr.C.V.Subba Rao,
Saptagiri Nursing Home,
D.No.11-3-3, Angadalavari Street,
Kothapet, Vijayawada-1. ..Appellant/
Opp.party.
And
Ch.V.Ramanjaneyulu S/o.Subba Rao,
Opp:Anurag Hospital
Kothapet, Vijayawada-1. Respondent/
complainant
Counsel for the Appellant: M/s.V.Gourisankara Rao
Counsel for the Respondent : Mr.Mohd.Shafiuddin
QUORUM: THE HON’BLE MR.JUSTICE D.APPA RAO, PRESIDENT.
SMT.M.SHREESHA, MEMBER.
AND
SRI G.BHOOPATHI REDDY , MEMBER.
FRIDAY, THE THIRTEENTH DAY OF JUNE
TWO THOUSAND EIGHT.
ORAL ORDER: (Per Smt.M.Shreesha, Hon’ble Member)
***
Aggrieved by the order in C.D.No.104/2003 on the file of District Forum-II, Vijayawada, opposite party preferred this appeal.
The brief facts as set out in the complaint are that the complainant had general weakness and approached opposite party for treatment on 26-5-2002. The complainant was examined by opposite party and was directed to undergo investigations and blood test at Vijaya Durga Laboratories. Accordingly the complainant underwent all the necessary tests and he was informed that his was a simple case of general debilitation and was discharged on the same day. The complainant once again approached opposite party on 28-5-2002 and was asked to undergo ultra sound scan test at Sowmya Diagonostics and was admitted as inpatient in their Nursing Home. The opposite party informed the complainant that he had tiny stones in Kidney and would be cured by medicines. On 29-5-2002, opposite party accompanied by a nurse came to the complainant’s bed in night rounds and instructed the nurse to administer an injection to the complainant. Thereafter when the nurse was administering the injection to the complainant, he had a feeling of electric shock in his hand and within a few seconds his right wrist dropped and he was completely immobilized. He was assured that it would be set right by the use of medicines. As there was no improvement, opposite party referred the complainant to an expert Neurologist by name K.V.V.Satyanarayana Murthy but still he did not get any relief and he was informed that he would regain mobility at a slow phase. The complainant also got himself treated at NIMS for the immobilized wrist but still he did not get any relief. The complainant submits that it is only due to imprudent and negligent act of the nurse in administering the injection that he was completely immobilized. He got issued a legal notice on 10-2-2003 to the opposite party and on 20-2-2003 opposite party gave reply with all false allegations. The complainant got issued another legal notice on 04-2-2003 for which opposite party replied once again denying negligence. Vexed with his attitude, the complainant approached the Forum seeking a direction for compensation of Rs.3,00,000/- together with costs of Rs.5,000/- and Rs.50,000/- towards mental agony.
Opposite party filed counter stating that ever since he started his professional career, he is in the habit of opening a case file for every patient and the case file will be handed over to the patient for safe custody. He submitted that the case file of the complainant is not in his custody and on receipt of the legal notice, he requested the complainant to give the full details of the file but the complainant did not furnish any details. Opposite party further contended that the complainant never continued treatment from him nor did he informed him about the progress made and for the reasons best known to him did not follow the instructions given by the doctors and that the complainant himself is responsible for the unfortunate partial immobility of the right arm. Opposite party further submits that it was only on 26-5-2002 that the complainant approached him and he was injected with fluids as he was weak. He was never admitted as inpatient on that day and again on 28-5-2002 as the complainant was suffering from fever and pain on the right side of the chest, x-ray and clinical examinations were done and pneumonia was suspected on the right side of the lung together with infection in gall bladder and stones in the right kidney. So he was advised admission in nursing home. The treatment continued from 28-5-2002 to 01-6-2002 and on 01-6-2002 when the complainant was being discharged, he complained of pain in the right side of the chest and the opposite party instructed the staff nurse to administer DICLOFENAC injection, which is a pain killer. The administration of the injection by the nurse was uneventful and on 2-6-2002 when the opposite party went round the patients’, at that time, the complainant expressed that he was having pain in his hand ever since administration of the injection. It was found that the complainant was having tingling and numbness in his right upper arm after the injection was given. Examination showed reflexes were present and there was apparent wrist drop though muscle movements were present. The complainant was assured of recovery and was advised to go for physiotherapy. On 3-6-2002 on the advise of the opposite party as the patient was comfortable, he starting pressing exercises with rubber balls and he was discharged, with no specific problem. On 8-6-2002 the complainant visited the opposite party and he informed that he consulted Neuro Surgeons, who advised him to take medication and physiotherapy. On 12-7-2002, he once again visited opposite party and complained about weakness in the right wrist, opposite party contacted Dr.Naresh Kumar, Physiotherapist, and fixed an appointment for the complainant. Thereafter the complainant never contacted him and he only came to know from Dr.Naresh Kumar that the physiotherapy treatment was not completed by the complainant. Opposite party submits that he had taken every care and shown diligence and therefore there is no deficiency of service and seeks dismissal of the complaint.
The District Forum based on the evidence adduced i.e. Exs.A1 to A20. Ex.X1 and also the examination of P.Ws 1 and 2, R.Ws.1 and 2 allowed the complaint directing the opposite party to pay Rs.1,00,000/- towards compensation and Rs.3,000/- towards costs with a default clause of 12% p.a. interest on non compliance of the order within one month.
Aggrieved by the said order, opposite party preferred this appeal.
The learned counsel for the appellant submitted that the respondent/complainant intentionally suppressed the discharge summaries and Nerve Conduction Study reports issued by NIMS, Hyderabad and National Institute of Mental Health and Neuro Science, Bangalore and that there is no evidence to show that Radial Nerve Palsy occurred because of an injection alleged to have been given at the hospital of the appellant. The learned counsel contended that there are various reasons for the development of Radial Nerve Palsy such as pressure on Radial Nerve by head during sleep, general injuries etc., He contended that the development of Radial Nerve Palsy during the respondent’s stay in the hospital is a mere co-incidence and not because of the alleged administration of injection. P.W.2, Dr.K.Naresh Kumar did not depose that Radial Nerve Palsy developed in the respondent because of improper administration of the injection. The District Forum failed to appreciate the evidence of Dr.K.Naresh Kumar in the right perspective. P.W.2 deposited that the respondent improved 25% of his wrist movement and inspite of his advise for continuation of the treatment, the respondent did not turn up. The learned counsel further contended that had the reports been filed, they would have revealed the nature of the injury of Radial Nerve Palsy and without establishing the cause for Radial Nerve Palsy, the Forum erred in coming to the conclusion that it occurred because of administration of injection in the appellant hospital.
The learned counsel for the respondent submitted that it was only after administration of the injection that the complainant felt electric shock and there was wrist drop. The cause for wrist drop has to be explained by the doctor himself since it occurred in the nursing home of the doctor, which necessitated the complainant to go to several experts and also continue treatment under a physiotherapist.
The brief point for consideration is whether there is any negligence on behalf of the doctor in treating the patient?
We have perused the material on record. There is no dispute that the respondent/complainant had approached the appellant doctor on 26-5-2002 and 28-5-2002 for fever, pain on the right side of his chest. The appellant doctor admitted that he treated the patient till 01-6-2002 and in his counter, the appellant admitted that on 02-6-2002 which is just before they had planned to discharge the respondent, he complained of pain in his hand. It is not in dispute that an injection DICLOFENAC was administered to the respondent, which was a pain killer. It is the respondent’s case that it is only due to the negligent administration of that injection that there was a feeling of electric shock in his hand followed by severe pain and wrist drop. In para 5 of page 4 of his counter, the appellant stated as follows:
‘On 2-6-2002 when this opposite party went to the Nursing
Home in the morning, it was informed that the complainant
is feeling lot of pain in his hand after the administration of
injection in the night necessitating the personal inspection of the
patient by this opposite party. It was found out on examination
that the patient was complaining of tingling and numbness in
right upper limb after Diclofenac injection given in the night for
pain relief. Examination showed reflexes were present and there
was apparent wrist drop though muscle moments were present.
The patient was assured that it is absolutely curable and was
suggested of physiotherapy exercises’.
From the aforementioned admission in the counter, it is clear that the respondent suffered wrist drop and pain immediately after administration of the injection. The appellant had also stated in his written version that on 8-6-2002 and 12-7-2002 the respondent again visited him with pain in his wrist and he had suggested physiotherapy and also contacted Dr. Naresh Kumar, a practicing Physiotherapist, to treat the patient. It is the appellant’s case that thereafter the respondent never visited him and he only came to know from Dr.Naresh Kumar that the treatment was not complete. It is the appellant’s case that it is only because of improper treatment that the wrist condition improved and it has nothing to do with the negligent administration of the injection. The learned counsel for the appellant also filed medical literature NATARAJAN’S TEXT BOOK OF ORTHOPAEDICS AND TRAUMATOLOGY and in Page 288 it is stated as follows:
‘RADIAL NERVE INJURIES:
Anatomical factors:
Radial nerve is formed from the posterior cord of brachial
plexus in the axilla (C5, C6, C7, C8, T1). It winds around the mid
shaft of humerus in the spiral grove and gives off the posterior
interrosseous nerve just above the elbow and continues as the
superficial branch of Radial nerve’.
‘Pressure on the nerve when a person sleeps with his arm resting
over the edge of the cot causes wrist drop. Such a pressure
can also occur in a drunken man sleeping off in a sofa with the arm
on the top edge of the seat. The nerve is accidentally injured when
intramuscular injections of Pencillin or Tetracycline are carelessly
given in the lower part of the arm’.
He also relied on page 77 of ‘A MANUAL ON CLINICAL SURGERY’ in which it is stated as follows:
‘Radial nerve may be injured when a person is asleep or by inadvertent
intramuscular injection on the radial nerve at this region’.
In Volume Four Tenth Edition of CAMPBELL’S OPERATIVE ORTHOPAEDICS, it is stated at page 3257 as follows:
‘Other causes include lacerations of the arm and proximal forearm,
injection injuries and prolonged local pressure’.
This literature does not support the contention of the appellant and the learned counsel’s argument that it is a mere co-incidence and could have happened during sleep or otherwise and that the respondent did not establish beyond doubt that the radial nerve palsy occurred only because of negligent administration of the injection. We find this contention unsustainable since it is apparent from the record i.e. written version and deposition that the wrist drop had occurred in the patient after administration of the injection. We also do not find force in the contention of the appellant that the original case sheet and the entire record is handed over to the patient and that he does not even have the copy of the discharge summary. It is a matter of common knowledge that any doctor running a nursing home should maintain records and keep copies of medical treatment rendered to the patient. Even in the deposition of Dr.Naresh Kumar, the patient did suffer from wrist drop, he only deposed that there was 25% improvement from physiotherapy. The contention of the appellant that the cause for Radial Nerve Palsy was not explained by the respondent is unjustified on the basis of the judgement of the Apex Court in (2004) 8 SUPREME COURT CASES 56 in SAVITA GARG (SMT) v. DIRECTOR, NATIONAL HEART INSTITUTE that
‘when a prima facie case is established, it is the duty of the opposite parties to prove their case, since it is only the opposite parties who are aware of the exact line of treatment that has been given to the patient. It was also held by the Apex Court that once a claim petition is filed and the complainant has successfully discharged the initial burden that the hospital/clinic/doctor was negligent and that as a result of such negligence, the patient died, then in that case, the burden lies on the hospital and the doctor concerned, who treated the patient, to show that there was no negligence involved in the treatment’.
The appellant in his counter stated that there was pain in the wrist of the respondent immediately after administration of the injection and it is the duty of the appellant to explain how this had developed immediately after administration of the injection. It is an admitted fact that the respondent was admitted in the hospital of the appellant for fever and pain in the right side of the chest and was discharged with a totally different problem of wrist drop. Therefore, we are of the considered view that there is no reason to interfere with the order of the District Forum with respect to medical negligence and compensation awarded since this wrist drop created discomfort, inconvenience and mental agony to the respondent and he also had to incur expenses towards physiotherapy. However, we reduce the interest on the awarded amount in default from 12% to 9% p.a. and confirm the rest of the aspects of the order of the District Forum. Time for compliance four weeks.
In the result this appeal is allowed in part and the order of the District Forum is modified by reducing the interest on the awarded amount in default from 12% to 9% p.a. and confirm the rest of the aspects of the order of the District Forum. Time for compliance four weeks.
PRESIDENT. LADY MEMBER. MALE MEMBER.
JM DATED 13-6-2008 .
