CC Filed on 26.04.2007<br /> Disposed on 04.11.2008<br /> BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, KOLAR.<br /> <br /> Dated: 4th day of November 2008<br /> <br /> PRESENT:<br /> Sri. G.V.HEGDE, President.<br /> Sri. T.NAGARAJA, Member.<br /> Smt. K.G.SHANTALA, Member.<br /> ---<br /> <br /> Consumer Complaint No.93/2007<br /> <br /> Master Jayanth Kumar,<br /> S/o P.Nagaraj,<br /> Aged about 08 years,<br /> Student,<br /> Studying at ;<br /> Happe Gowdanahalli Primary School,<br /> <br /> The complainant is a Minor, <br /> Hence, Rep: by his father <br /> And natural guardian <br /> Sri. P.Nagaraj,<br /> Major, R/a Happe Gowdanahalli village,<br /> Kasaba Hobli,<br /> Sidlaghatta Taluk. ….Complainant <br /> (By Advocate Sri. K.Narasimhagowda & Others) <br /> <br /> V/S<br /> Dr. D.T.Sathyanarayana Rao,<br /> M.B.B.S. M.D.,<br /> Physician,<br /> Professor of Sushrutha Nursing Home,<br /> Ashoka road, <br /> Sidlaghatta Town,<br /> Kolar Dist. ….Opposite Party<br /> (By Advocate Smt. Shobha Rani S.N.) <br /> <br /> ORDERS<br /> This is a complaint under section 12 of the Consumer Protection Act, 1986 praying for a direction against the opposite party to pay compensation of Rs.3,00,000/- in all towards the medical expenses <br /> <br /> CC No.93/2007<br /> already incurred and future medical expenses to be incurred and towards mental shock, pain and suffering, arising out of medical negligence of opposite party with costs and interest etc.,<br /> <br /> 2. The material facts of the case of complainant as may be gathered from the pleadings and documents produced by complainant, may be stated as follows: The complainant was aged about 8 years at the time of filing the complaint. He is represented by his next friend – father and natural guardian T.Nagaraj. It is alleged that on 08.10.2006 the complainant was taken to the Nursing Home of OP for treatment as he was suffering from fever. The OP examined and prescribed some medicine and that inspite of it the fever did not subside, therefore the complainant was again taken on 22.10.2006 to the Nursing Home of OP. It is alleged that on this day the OP gave some injection on the right buttock of complainant and within two minutes the complainant suffered a lot of pain and swelling occurred on injection site and that the complainant’s father on seeing the condition of complainant again met the OP but he told that nothing would happen and advised to take the complainant to house for rest. Accordingly the complainant was taken to his house and on the next morning it was found that the right leg of complainant had become senseless. <br /> <br /> The complainant was again taken to OP on the same day (23.10.2006) and showed the complainant to OP. Then the OP examined and prescribed some tablets and advised to come again after 10 days. It is alleged that the complainant did not show any improvement and on the contrary, the condition of his right leg deteriorated further. Then the complainant was taken to Aswini Hospital, Yalahanka, Bangalore on 24.10.2006 for treatment. He was admitted there as inpatient and was discharged on 26.10.2006 with certain follow up medicine. The <br /> <br /> CC No.93/2007<br /> complainant was taken to Mallige Nursing Home on 30.10.2006. One Dr. B.P.Mruthyunjayanna (told to be a neurologist) examined the complainant and referred him for relevant test to find out the defect in the nerves. The complainant was taken to Elbit Diagnostic Ltd., Bangalore as suggested by Dr. B.P.Mruthyunjayanna and the said diagnostic center gave its finding after conducting required tests. Dr.B.P.Mruthyunjayanna prescribed certain medicines on going through the report of Elbit diagnostic center. It appears the complainant appeared before the same doctor on subsequent future dates for follow up. It is alleged in the complaint that the complainant was taken to the Nursing Home of OP on 05.11.2006 and the OP examined the complainant and gave Imol injection and prescribed some medicine. It is alleged that inspite of the treatment of OP, day by day the right leg of complainant was becoming thinner, and the treatment of OP became useless. It is alleged that the complainant was also taken to different Hospitals in Bangalore including K.I.M.S. Hospital Bangalore on 12.12.2006 and Sathya Sai Institute of Higher Medical Sciences, White Field Bangalore on 28.06.2007 for expert examination. It is alleged that the complainant spent more than Rs.1,00,000/-. Therefore it is alleged that the foot drop is caused to complainant due to the negligence while giving the injection by OP on 22.10.2006 causing injury to sciatic nerve. Hence complaint is filed on 26.04.2007 against OP. <br /> <br /> 3. The OP appeared and files his version as follows: OP denied that the complainant was brought to him on 08.10.2006 or 22.10.2006 for any treatment. He contended that only on 05.11.2006 the complainant was brought to him with history of fever for the fast few days repeatedly accruing and since the fever was frequent the father of complainant requested to give an injection and the OP prescribed an injection namely ‘mol’ a parcaetamol and asked the father of complainant to get the same <br /> CC No.93/2007<br /> and the complainant brought that injection and OP gave that injection and prescribed tablets namely Medmol -10 tabs, Zifi – 6 tabs which were standard drugs, for three days and asked to come after three days if the fever was not controlled to have a blood check up. OP also contended that the medical records produced by complainant disclose that there was damage to the peroneal nerve which runs below the knee of the leg. Further he contended that the said ailment is caused due to various reasons as per medical science, like infections (viral and bacterial) mal nutrition, local compression of the nerve because of various external injuries and diseases which lie unnoticed or forgotten events occurring weeks or months prior to the onset of symptoms and like exposure to pesticides, chemicals and can also be caused due to internal muscle pressure, tight plaster costs, tight knee boots, prolonged pressure, weakness of foot dorsiflexion and eversion etc., He also contended that the treatment given to the complainant was a free service and this Forum cannot take cognizance of the complaint for this reason also. He contended that he is a qualified doctor having M.B.B.S, MD (General Medicine) qualification and he is efficient and that the complaint is misconceived on the wrong advise of some persons. Therefore he requested to dismiss the complaint with costs. <br /> <br /> 4. The complainant has filed his affidavit by way of examination in chief and he is cross examined. The OP has filed affidavit by way of examination in chief and he is also cross examined. Both parties filed certain documents. We heard the arguments after closure of the evidence. The defense that the service rendered by OP was free of charge is not pressed during argument. <br /> <br /> <br /> <br /> CC No.93/2007<br /> 5. From the rival contentions the following points arise for our consideration: <br /> 1. Whether there was deficiency in service by OP?<br /> 2. If so to which reliefs the complainant is entitled to? <br /> 3. What order?<br /> <br /> 6. After considering the records and the submissions of parties our findings on the above points are as follows:<br /> <br /> Point No.1: The specific case of the complainant is that his right sciatic nerve was injured while giving injection by OP on the gluteal region on 22.10.2006. He alleged that immediately thereafter he suffered lot of pain and swelling on the injection site and on the next day his right leg became senseless. According to him on 23.10.2006 also he approached OP. It is alleged that on 24.10.2006 he was admitted in Aswini Hospital as inpatient till 26.10.2006. It appears the complainant was treated in Aswini Hospital only on the basis of clinical tests. The discharge summary issued by Aswini Hospital is produced at a belated stage. On the basis of clinical tests the doctor in Aswini Hospital suspected iatrogenic foot drop (Bl). The history of the complaint is not recorded in Aswini Hospital. In case of suspected iatrogenic foot drop it was very essential to mention the history of complaint. <br /> <br /> The complainant was taken to Mallige Hospital on 30.10.06. One Dr. B.P.Mruthyunjayanna said to be a neurologist referred the complainant to Elbit Medical Diagnostics Ltd., The complainant was examined in that diagnostic center. After required tests the said diagnostics center concludes – “Impression --- R- common peroneal neuropathy denoting mononeuritis simplex”. The OP states that this diagnosis denotes the damage to the right peroneal nerve which runs <br /> <br /> <br /> CC No.93/2007<br /> below the knee of the leg and the said ailment is caused due to various reasons. <br /> <br /> The complainant was taken to KIMS Hospital on 12.12.2006. They found that there was right foot drop on the basis of clinical examination. It appears no laboratory tests were conducted to find out the exact nerve damaged. The complainant was examined on 28.06.2007 in Sri Sathya Sai Institute of Higher Medical Sciences. The observation and conclusion arrived there are as follows: <br /> “Neuro Diagnostics ENMG SUMMARY REPORT:- The motor study of right posterior tibial nerve is normal. The right comman peroneal nerve SNAP od right sural is normal. The right superficial peroneal nerve SNAP is absent.<br /> EMG of right tibialis anterior shows reduced voluntary motor unit activity with long duration units.<br /> CONCLUSION—In this clinical context, this findings suggest right sciatic nerve palsy involving peroneal division”. <br /> <br /> The complainant has not produced any expert evidence. We think expert evidence was necessary in this type of case. The above laboratory tests of Elbit Medical Diagnostics Ltd., and Sri Sathy Sai Institute may suggest as far as we understand that there was damage to the peroneal nerve which runs below the knee of the leg. These findings may not suggest that there was injury to the sciatic nerve. The complainant has alleged that there was injury to sciatic nerve after IM injection 22.10.2006. The injury to sciatic nerve may lead to foot drop. That fact cannot be disputed. There are various reasons for the injury to sciatic nerve. In neurology book produced by OP it is stated as follows: <br /> “The sciatic nerve is commonly injured by fractures of the pelvis or femur, fracture/dislocation of the hip, gunshot wounds of <br /> CC No.93/2007<br /> the buttock and thigh, and the injection of toxic substances into the lower gluteal region. Total hip arthroplasty is another common cause. Tumors of the pelvis (sarcomas, lipomas) or gluteal region may compress the nerve. Sitting for a long period with legs flexed and abducted (lotus position) under the influence of narcotics or barbiturates or lying flat on a hard surface in a sustained stupor may severely injure one or both sciatic nerves or branches thereof. The nerve may be involved by neurofibromas and infections and by ischemic necrosis in diabetes mellitus and polyarteritis nodosa. Cryptogenic forms also occur and are actually more frequent than those of identifiable cause. Partial lesions of the sciatic nerve occasionally result in causalgia (see further on).<br /> The common Morton neuromas cause interdigital or intermetatarsal pain and can be detected by MRI. It is subject to surgical section. Also mentioned here is the distressingly painful compression of the plantar branches of the sciatic nerve”.<br /> <br /> The causes for injury or damage to common peroneal nerve are stated as follows: <br /> “Pressing during an operation or sleep or from tight plaster casts, obstetric stirrups, habitual and prolonged crossing of the legs while seated, and tight knee boots are the most frequent causes of injury to the common peroneal nerve. The point of compression of the nerve is where it passes over the head of the fibula. Emaciation in patients with cancer or AIDS increases the incidence of these types of compressive injury. The nerve may also be affected in diabetic neuropathy and injured by fractures of the upper end of the fibula. A Baker cyst, which consists of inflamed synovium extending into the retropopliteal space may compress <br /> <br /> CC No.93/2007<br /> the nerve, and it may be damaged by muscle swelling or small hematomas behind the knee in asthenic athletes. The prognosis is generally good in cases of partial paralysis”. <br /> <br /> Elbit Medical Diagnostics Ltd., concluded on 30.10.2006 that there was ‘right common peroneal neuropathy denoting mononeuritis simplex’ which suggests the damage to the peroneal nerve. The test conducted on 28.06.2007 at Sri Sathya Sai Institute concluded that right sciatic nerve palsy involving peroneal division. Therefore these findings do not suggest the exact location and nature of the injury to sciatic nerve. It appears MRI tests could have pointed out the nature and location of the injury to sciatic nerve. Therefore we believe that the medical papers produced by complainant even if taken on its face value, do not establish that there was injury to sciatic nerve due to IM injection. <br /> <br /> 7. The father of complainant is examined as PW-1. In the complaint it is alleged that the complainant was taken to OP on 08.10.2006, 22.10.2006 and 05.11.2006. Further the averment in the complaint implies that the complainant was also taken to OP on 23.10.2006. The OP contended that only on 05.11.2006 the complainant was brought to him but not on any previous dates. In the examination in chief the complainant has sworn the same facts as alleged in the complaint regarding the different dates of visit to OP and other facts. But in the cross examination he stated that the complainant was taken for the first time for treatment before OP on 18.10.2006 and thereafter he was taken to OP on 20.10.2006 and 22.10.2006. During the cross examination of OP it is suggested that on 05.11.2006 the complainant was not brought to OP for any treatment but on that day father of complainant had alone come just to get the name of injection from OP administered on 22.10.2006. This suggestion is denied by OP. This suggestion shows that <br /> <br /> CC No.93/2007<br /> the pleading and the evidence of complainant that he was also taken on 05.11.2006 was not correct. Therefore considering the oral evidence as a whole one can say that there is material contradiction and inconsistency regarding the dates on which the complainant was taken to OP for treatment. In such circumstance the history of the ailment if any reported by father of complainant while admitting the complainant to Aswini Hospital on 24.10.2006 would have become most important fact, to ascertain whether the version of complainant that he was taken to OP on 22.10.2006 and an IM injection was given to him on that day which led to the complication, should be believed or not. <br /> <br /> The OP strongly denied the genuinety of the contents of discharge summary issued by Aswini Hospital. As already noted it is produced at a belated stage. It is admitted that a doctor by name L.M.Nagaraj is a relative of complainant’s father. It appears that the said Dr. L.M.Nagaraj was also visiting Aswini Hospital as a consultant. One of the bills issued by Aswini Medical Shop dated 24.10.2006 shows that the Dr. L.M.Nagaraj had prescribed the medicines sold under the said bill. The said doctor had prescribed Monocef injections and some other medicines. The OP doubted that even these injections might have caused the complication and the present complaint was probably filed with false allegations at the instance of that doctor. Therefore what history was really given by complainant’s father while admitting the complainant to Aswini Hospital was a material fact. In case of Iatrogenic complication, it appears to us that the doctor examining such a patient is bound to make a detailed history of the complication before commencing the treatment. Because it involves certain negligence or fault on the part of another physician while giving treatment. But the discharge summary of Aswini Hospital does not disclose any history of complication though it is suspected as Iatrogenic foot drop. For these reasons we hold that the <br /> <br /> CC No.93/2007<br /> oral evidence of complainant’s father that the complainant was taken to OP on 22.10.2006 for treatment and an IM injection was given on that day, is not supported by any direct or circumstantial evidence. For these reasons we hold that the complainant has failed to establish that there was an injury to sciatic nerve due to IM injection which led to foot drop and that on 22.10.2006 he had taken the complainant to OP for treatment and OP had given an IM injection on gluteal region. Accordingly point No.1 is held in negative. <br /> <br /> Point No.2: As point No.1 is held in negative, point No.2 does arise for consideration. The complainant has produced medical bills to the extent of Rs.15,426/-. He visited various hospitals in Bangalore on different dates. Therefore the total medical expenses already incurred may be taken at Rs.50,000/-. The complainant might have recovered to a great extent by this time. We infer like this because the complainant was not produced before the Forum though we had instructed for his personal appearance. If negligence was proved totally compensation of Rs.1,00,000/- could have been awarded. <br /> <br /> Point No.3: For the above reasons we pass the following:<br /> <br /> O R D E R <br /> The complaint is dismissed. Parties shall bear their own costs. <br /> <br /> Dictated to the Stenographer, corrected and pronounced in open Forum this the 04th day of November 2008.<br /> <br /> <br /> MEMBER MEMBER PRESIDENT<br /> <br /> <br /> <br /> <br /> <br />