Reserved

State Consumer Disputes Redressal Commission

U.P. Lucknow.

Complaint Case no.125 of 2017

1- Romel Soni s/o Late Ramji Kaushal Soni

2- Smt. Vinita Soni w/o Shri Romel Soni,

both resident of 555 Cha/48 ,SaiKripa,

Ram Nagar, PS- Manak Nagar, District

Lucknow.                                                      …Complainants.

Versus

1. King George Medical University, Uttar Pradesh,

Lucknow through its Registrar.

2. Professor Ajay Singh, King George Medical

University, Uttar Pradesh, Lucknow

3. Dr. Vineet Kumar, Surgeon, King George

Medical University, Uttar Pradesh, Lucknow.

Present:-

1- Hon’ble Mr. Rajendra Singh, Presiding President.

2- Hon’ble Mr. Vikas Saxena, Member.

Mr. Vikas Kumar Agarwal, Advocate for the complainants.

Mr. Uttam Kumar Srivastava, Advocate for the opp. parties.

Date  :   23.08.2022

JUDGMENT

Per Mr. Rajendra Singh, Member: The present complaint has been filed under section 12 of the Consumer Protection Act 1986. In brief the facts of the complaint case are that, that gross error of diagnosis and medical negligence committed by the opposite parties/doctors while diagnosing and administering treatment on the complainant no.1 from 08.02.2016 to 11.02.2016 in Trauma Centre of Chhatrapati Sahuji Maharaj Medical University (formerly known as KGMU) and failed to follow his duty of care towards the patient/complainant. The both hands of the complainant no.1 were badly injured due to falling from the train on 08.02.2016 and thereafter he was admitted in Bandhu Shri Raj NarainSanyuktChikitsalaya, Kanpur Road, Lucknow at 11:45 AM and thereafter the doctors of the said hospital has referred the case to Trauma Centre (KGMU) for treatment. The complainant no.1 was admitted in trauma Centre on the same day and his case was handled by two doctors namely Prof. Ajay Singh (MS FSS  MNAMS) and Dr. Vineet Kumar (MS) another same day, treatment has been started under the supervision of the above named doctors and all the necessary tests and x-ray has been carried out and the complainants have also stated to the doctors that he is sugar patient but no drug in respect of the sugar control has been given. Thereafter on 10.02.2016, complainant was taken in operation theatre for the minor surgery in the injured hands and when the doctor of Anastasia came there and he found the random Sugar level of the complainant no.1 was 279 and k+ 5.84, he has written in the treatment card that the complainant has not been given anymedicine for controlling sugar for the last two days and he has also stated in his note that no chart prepared for Sugar level and no other report is available and therefore he has recommended for giving the medicine to the complainant for Sugar control and also recommended for some test in respect of the Sugar level and thereafter minor surgery has been done on 11.02.16.

Being the patient of sugar, the complainant no 1 was not advised to take medicines to control sugar and the doctors have also not taken random Sugar test at the time of the admission of the complainant on 08.02.16 itself, though it is a general course of treatment in a case of injury like complainant that care has to be taken before starting the treatment but the opposite parties/doctors have not taken care to test the random Sugar test on 08.02.16 and avoided the same for the next three days and during this period, due to Sugar, complainant’s  no 1 injury condition got deteriorated. During the time of the treatment i.e. 08.02.16 to 11.02.16, the opposite parties/doctors have stated to the complainant about his injury condition is not so bad and it would be cured with minor surgery and there is no need to ampute the right-hand. The attendant of the complainant when came to know that complainant was not given Sugar control drug for the last three days and when the attendant of the complainant approached the doctors of the SIPS Super SpecialityHospital, Burn and Trauma Centre/opposite party no.4 and remain in constant touch with them and admitted the complainant at SIPS on 12.02.16 at 2:56 AM. Thereafter the complainant no 1 was admitted at SIPS and investigation has been conducted by the doctors and it was found that his right hand injury is badly affected and gangrene has taken place in his right hand injury and therefore the doctors of the SIPS has advised the complainant to ampute his right-hand above the elbow so that the infection may not cause further harm.

The above facts show that correct diagnosis has not been made by the opposite parties/doctors of KGMU and general course of treatment has also not been followed by them at the time when the complainant was admitted in the trauma centre and a consequence thereof substantial time was consumed by the doctors and due to that injured right hand of the complainant no 1 was infected with gangrene and due to this right-hand of the complainant had to be amputated and doctors of SIPS has advised to ampute the right-hand above elbow, which causes irreparable loss to the complainant which cannot be compensated in any event. As per medical terminology gangrene in the death of skin and soft tissues resulting from a reduction in the supply of oxygen carrying blood to the affected region. The primary cause of the gangrene is reduced blood supply to the affected tissues which results in cell death. Diabetes and long-term smoking increases the risk of suffering from gangrene. It is a serious condition that can be fatal and gangrene shall be treated urgently to halt the spread of tissues death as soon as possible and in the medical literature it has also been stated that diabetes is also a cause, by which gangrene could take place in injured place and can spread very rapidly and in the instant case, the complainant has not in a habit of tobacco smoking and was a patient of diabetes but doing course of treatment adopted by KGMU, Trauma Centre, no random Sugar test has been taken neither at the time of admission nor during the course of treatment and also no sugar chart has been prepared and due to this the complainant remained without sugar control drug for three days and due to this reason, gangrene took place in his right injured hand. It is pertinent to mention here that opposite parties have also not conducted any test to determine the type and extent of gangrene, which shows the gross negligence in the course of treatment.

One is fairly well settled principle in medical negligence jurisprudence that when a doctor commits gross error of diagnosis, he is to be held responsible for medical negligence. Hon’ble NCDRC in the case of Nand Kishore Verma  Vs. Batra Hospital, II(2007)CPJ 336 ( NC ) in which an award of ₹ 762,000/- granted in favour of the complainant. There are also other case laws in which the Hon’ble StateCommission has awarded compensation on account of the wrong diagnosis by a doctor. The complainant has spent an amount of ₹15,987/- on the treatment at Trauma Centre towards bed charges, surgical consumable and including medicines which were purchased from time to time. When the complainant was admitted in SIPS he spent ₹630,206/- including bed charges, surgical consumable and medicines. In the present case wife of the complainant no 1 has gone great mental stress and anguish together with pecuniary damages and therefore is fully entitled for damages/compensation from the opposite parties being quantified at ₹20 lakhs. Due to lack of care and wrong treatment by the opposite parties, the complainant no.1 lost his right-hand, which could be made good by means of the treatment and ultimately under the prevailing conditions was advised to be amputated above the elbow and being an engineer in a private company, the complainant no.1 has been disengaged by the company. Due to amputation, the complainant no 1 is not able to perform his daily routine work and always requires a person to help him for doing the daily routine work which also causes great mental agony and pain to the complainant for no fault of his own. The complainant no.1 suffered disfigurement of his body due to amputation and for rest of the life he has to remain on the support of prosthetic hand.

The complainant has been advised best prosthetic hand by several prosthesis manufacturing companies operating in India and out of them, the complainant has been best interested to go to prosthetic hand of “ENDOLITE” make having model in the name of ‘Below Above 3 Degree Myo- Electric hand complete with socket’ and by which the complainant can perform his daily routine work without being dependent on others and which will also reduce his disfigurement to some extent. The cost of the aforesaid prosthetic hand is ₹4 lakhs approximately. Due to sheer negligence of the opposite parties no.1 to 3 the complainants have been compelled to file this complaint and therefore the complainants are entitled for litigation cost from the opposite parties. Therefore the complainant claims the following reliefs:-

1. amount spent at trauma centre, KGMU towards bed charges, surgical consumable and including medicines - ₹ 15,987/-.

2. amount spent at SIPS towards bed charges, surgical consumable and including medicines ₹ 630,206/-.

3. cost of prosthetic hand  ₹ 4 lakhs.

4. amount of damages/compensation to the complainant no 1 on account of amputation of right-hand below elbow due to wrong diagnosis and treatment by the opposite parties no.1 to 3 ₹ 40 lakhs.

5. Amount of damages/compensation on account of mental stress and anguish suffered by the complainant no 2 due to wrong diagnosis and treatment from opposite parties no 1 to 3 -₹ 20 lakhs

6. Amount on account of litigation cost - ₹ 50,000/-.

7. Any other reliefs, which this Hon’ble Commission may deem fit and proper in the circumstances of the case, may also be granted in favour of the complainants.

8. Amount of damages/compensation to the complainant no 2 on account of mental stress and anguish together with pecuniary damages by the opposite parties no.1 to 3                                        -₹ 20 lakhs

So the complainant prays for grant of the above mentioned reliefs in their favour from the opposite parties.

The opposite parties filed their written statement in which they have stated that complainant no.1,RomelSoniwas referred from Lok BandhuSanyukta Hospital after the primary treatment to the Orthopaedic Emergency Unit, Trauma Centre KGMU on 08.02.2016 at 8:54 PM as a case of crush injury (L) elbow and forearm with crush injury (R) forearm and hand is as a result of fall from train. On 08.02.16 just after admission of complainant no.1 at trauma centre KGMU his detailed clinical examination and routine blood investigations including Random Blood Sugar was done, same could easily evidenced the from the documents of complaint. The patient gave history of diabetes mellitus as such he was asked to continue oral Hypoglycaemic Agents (OHA) which he was already having (patient had no records with him related with diabetes at the time of admission). On receiving investigation report Random Blood Sugar of complainant no.1 was found to 279.8 mg/dl. It is well established in the medical literature that there is rise in blood sugar in response to stress and trauma which complainant was suffering was major cause of stress. Patient was advised repeat test of blood sugar FF/PP and till then was advise to continue on OHA. Complainant was also advised for the skeletal stabilization. In case of complainant consultant of plastic surgery reference was obtained in which there is a clear note mentioning gangrenous changes in reposited flap. Plastic surgery operation was planned at for which an anaesthesia consultation was obtained in which they advised to get a mention reference for DM.

On 10.02.2012, FF/PP along with HbA1C of complainant was done and on the same day medicine consultation was obtained in which they advised that patient can be taken for surgery under moderate risk after anaesthesia clearance. It was also advised to stop OHA and to start neutralising drip and to maintain perioperatibe the sugar in range (142-180) and to titrate R-insulin dose accordingly. All advice were followed thereafter patient was taken for surgery on 10.02.12 and the Skeletal Stabilisation was done. On the subsequent day i.e. 11.02.12 in the post-operative period patient insisted for LAMA (Left Against Medical Advice) and on the same day the patient went on LAMA despite of all the prognosis explained. A case of complainant no.1 proper diagnosis was made and there was no other in his medical treatment. Random Blood Sugar was done on the night of 08.02.16 at 1:45 AM ( 09.02.16) which is the date of admission of complainant and thereafter fasting and PP were done in the morning of 10.02.2016. Prognosis of patients/complainant no.1 injured limbo was explained to him at the time of admission and also plastic surgery reference was obtained. Viability issue of the limb are always discussed with the expert i.e. the plastic surgeon and the decisions taken accordingly. The lime of complainant no.1 was already infected due to injury as it was a crushed injury. Amputation was done in private hospital. The allegation of negligence as stated in complaint is false vague as such complainant is not entitled for the reliefs claimed by him in the instant complaint.

In case of the complainant, the correct and proper treatment protocol was followed and proper treatment protocol was followed but the patient insisted and went for LAMA despite of all prognosis explained to him. The complainant has not mentioned the date of amputation of right arm. Without expert opinion it cannot be said that amputation of right-hand of complainant is the result of alleged negligence of answering opposite parties. Regarding expenditure of amputation of his right hand at SIPS, the answering opposite parties cannot be held responsible for it. It is submitted that in case of complainant, correct diagnosis was made and proper treatment protocol was followed. In view of the submission made above, the complaint is liable to be dismissed.

We have heard the learned counsel for the complainant Mr. Vikas Kumar Agarwal and learned counsel for the opposite parties Mr. Uttam Kumar Srivastava. We are also perused the pleadings, evidence and documents on record.

First we have seen the LAMA dated 11.02.16 in which it has been written that the patient left against medical advice without taking hospital property and medical advice. So it is clear that despite of telling all the facts, the complainant himself and voluntarily left the trauma centre.

Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose). Glucose is vital to your health because it's an important source of energy for the cells that make up your muscles and tissues. It's also your brain's main source of fuel.

The underlying cause of diabetes varies by type. But, no matter what type of diabetes you have, it can lead to excess sugar in your blood. Too much sugar in your blood can lead to serious health problems.

Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes and gestational diabetes. Prediabetes occurs when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes. And prediabetes is often the precursor of diabetes unless appropriate measures are taken to prevent progression. Gestational diabetes occurs during pregnancy but may resolve after the baby is delivered.

Symptoms

Diabetes symptoms vary depending on how much your blood sugar is elevated. Some people, especially those with prediabetes or type 2 diabetes, may sometimes not experience symptoms. In type 1 diabetes, symptoms tend to come on quickly and be more severe.

Some of the signs and symptoms of type 1 diabetes and type 2 diabetes are:

• Increased thirst
• Frequent urination
• Extreme hunger
• Unexplained weight loss
• Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there's not enough available insulin)
• Fatigue
• Irritability
• Blurred vision
• Slow-healing sores
• Frequent infections, such as gums or skin infections and vaginal infections

Type 1 diabetes can develop at any age, though it often appears during childhood or adolescence. Type 2 diabetes, the more common type, can develop at any age, though it's more common in people older than 40.

Causes

To understand diabetes, first you must understand how glucose is normally processed in the body.

How insulin works

Insulin is a hormone that comes from a gland situated behind and below the stomach (pancreas).

• The pancreas secretes insulin into the bloodstream.
• The insulin circulates, enabling sugar to enter your cells.
• Insulin lowers the amount of sugar in your bloodstream.
• As your blood sugar level drops, so does the secretion of insulin from your pancreas.

The role of glucose

Glucose — a sugar — is a source of energy for the cells that make up muscles and other tissues.

• Glucose comes from two major sources: food and your liver.
• Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
• Your liver stores and makes glucose.
• When your glucose levels are low, such as when you haven't eaten in a while, the liver breaks down stored glycogen into glucose to keep your glucose level within a normal range.

Causes of type 1 diabetes

The exact cause of type 1 diabetes is unknown. What is known is that your immune system — which normally fights harmful bacteria or viruses — attacks and destroys your insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream.

Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what those factors are is still unclear. Weight is not believed to be a factor in type 1 diabetes.

Causes of prediabetes and type 2 diabetes

In prediabetes — which can lead to type 2 diabetes — and in type 2 diabetes, your cells become resistant to the action of insulin, and your pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into your cells where it's needed for energy, sugar builds up in your bloodstream.

Exactly why this happens is uncertain, although it's believed that genetic and environmental factors play a role in the development of type 2 diabetes too. Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with type 2 is overweight.

Causes of gestational diabetes

During pregnancy, the placenta produces hormones to sustain your pregnancy. These hormones make your cells more resistant to insulin.

Normally, your pancreas responds by producing enough extra insulin to overcome this resistance. But sometimes your pancreas can't keep up. When this happens, too little glucose gets into your cells and too much stays in your blood, resulting in gestational diabetes.

Risk factors

Risk factors for diabetes depend on the type of diabetes.

Risk factors for type 1 diabetes

Although the exact cause of type 1 diabetes is unknown, factors that may signal an increased risk include:

• Family history. Your risk increases if a parent or sibling has type 1 diabetes.
• Environmental factors. Circumstances such as exposure to a viral illness likely play some role in type 1 diabetes.
• The presence of damaging immune system cells (autoantibodies). Sometimes family members of people with type 1 diabetes are tested for the presence of diabetes autoantibodies. If you have these autoantibodies, you have an increased risk of developing type 1 diabetes. But not everyone who has these autoantibodies develops diabetes.
• Geography. Certain countries, such as Finland and Sweden, have higher rates of type 1 diabetes.

Risk factors for prediabetes and type 2 diabetes

Researchers don't fully understand why some people develop prediabetes and type 2 diabetes and others don't. It's clear that certain factors increase the risk, however, including:

• Weight. The more fatty tissue you have, the more resistant your cells become to insulin.
• Inactivity. The less active you are, the greater your risk. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
• Family history. Your risk increases if a parent or sibling has type 2 diabetes.
• Race or ethnicity. Although it's unclear why, certain people — including Black, Hispanic, American Indian and Asian American people — are at higher risk.
• Age. Your risk increases as you get older. This may be because you tend to exercise less, lose muscle mass and gain weight as you age. But type 2 diabetes is also increasing among children, adolescents and younger adults.
• Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of developing prediabetes and type 2 diabetes increases. If you gave birth to a baby weighing more than 9 pounds (4 kilograms), you're also at risk of type 2 diabetes.
• Polycystic ovary syndrome. For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.
• High blood pressure. Having blood pressure over 140/90 millimeters of mercury (mm Hg) is linked to an increased risk of type 2 diabetes.
• Abnormal cholesterol and triglyceride levels. If you have low levels of high-density lipoprotein (HDL), or "good," cholesterol, your risk of type 2 diabetes is higher. Triglycerides are another type of fat carried in the blood. People with high levels of triglycerides have an increased risk of type 2 diabetes. Your doctor can let you know what your cholesterol and triglyceride levels are.

Risk factors for gestational diabetes

Pregnant women can develop gestational diabetes. Some women are at greater risk than are others. Risk factors for gestational diabetes include:

• Age. Women older than age 25 are at increased risk.
• Family or personal history. Your risk increases if you have prediabetes — a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You're also at greater risk if you had gestational diabetes during a previous pregnancy, if you delivered a very large baby or if you had an unexplained stillbirth.
• Weight. Being overweight before pregnancy increases your risk.
• Race or ethnicity. For reasons that aren't clear, women who are Black, Hispanic, American Indian or Asian American are more likely to develop gestational diabetes.

Complications

Long-term complications of diabetes develop gradually. The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Possible complications include:

• Cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke and narrowing of arteries (atherosclerosis). If you have diabetes, you're more likely to have heart disease or stroke.
• Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward.

Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.

• Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
• Eye damage (retinopathy). Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
• Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.
• Skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
• Hearing impairment. Hearing problems are more common in people with diabetes.
• Alzheimer's disease. Type 2 diabetes may increase the risk of dementia, such as Alzheimer's disease. The poorer your blood sugar control, the greater the risk appears to be. Although there are theories as to how these disorders might be connected, none has yet been proved.
• Depression. Depression symptoms are common in people with type 1 and type 2 diabetes. Depression can affect diabetes management.

Complications of gestational diabetes

Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for you and your baby.

Complications in your baby can occur as a result of gestational diabetes, including:

• Excess growth. Extra glucose can cross the placenta, which triggers your baby's pancreas to make extra insulin. This can cause your baby to grow too large (macrosomia). Very large babies are more likely to require a C-section birth.
• Low blood sugar. Sometimes babies of mothers with gestational diabetes develop low blood sugar (hypoglycemia) shortly after birth because their own insulin production is high. Prompt feedings and sometimes an intravenous glucose solution can return the baby's blood sugar level to normal.
• Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.
• Death. Untreated gestational diabetes can result in a baby's death either before or shortly after birth.

Complications in the mother also can occur as a result of gestational diabetes, including:

• Preeclampsia. This condition is characterized by high blood pressure, excess protein in the urine, and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby.
• Subsequent gestational diabetes. Once you've had gestational diabetes in one pregnancy, you're more likely to have it again with the next pregnancy. You're also more likely to develop diabetes — typically type 2 diabetes — as you get older.

Now the next aspect is that whether stress and anxiety increase diabetes. It has been said by the opposite parties that due to stress, level of sugar increases the blood.

You have been challenged with the diagnosis of diabetes. Whether it is a new diagnosis or a longstanding one, living with this challenge can trigger a flood of emotions. Some of these emotions can include:

• Grief
• Anxiety
• Frustration
• Disappointment
• Stress

These emotions are natural responses and are experienced by many people, especially when they are first diagnosed with diabetes. These emotions might also be experienced by someone managing diabetes over the long term. Emotional issues may make it harder to take care of you—to eat right, exercise, and rest—which in turn can affect blood sugar control. In addition, you might find yourself trying to reduce stress with unhealthy behaviors, which can contribute to diabetes complications.

What is stress?

Most people experience stress as an emotional or physical strain. It can result in worry, anxiety, and tension. Everyday events or changes in life may create stress. Stress affects everyone to some degree, but it may be more difficult to manage when people learn that they have diabetes.

Symptoms of stress can include:

• Nervousness
• A fast heartbeat
• Rapid breathing
• Stomach upset
• Depression

Stress can make it more difficult to control your diabetes as it may throw off your daily routine and can result in wear and tear on your body. Hormones from stress increase your blood pressure, raise your heart rate, and can cause blood sugar to rise. High blood sugar can make you feel down or tired. Low blood sugar may result in your feeling upset or nervous.

Too much stress sometimes can lead to depression. People with diabetes are more likely to be depressed than the average person. You may be at risk for depression if you have any of the following symptoms for more than a week:

• Feeling sad or irritable
• Having lost interest in activities you enjoy
• Feeling worthless
• Having a change in sleeping patterns
• Feeling fatigued or like you have lost energy

Feelings of fatigue or feelings of worthlessness could make it harder to do self-care things that keep diabetes under control. It is important to remember that doctors can help to treat depression. 

Stress triggers an increase in the body's levels of the fight-or-flight hormone cortisol, as if you were under attack, explains Roger McIntyre, MD, professor of psychiatry and pharmacology at the University of Toronto in Canada. In response, the body releases extra energy into the bloodstream in the form of glucose. (That way, in case you are under attack, you have the fuel necessary to fight or flee.)

“When chronically heightened, cortisol works against glucose control even in people who don’t have diabetes,” Dr. McIntyre says. Yet people with diabetes are unable to properly process and store that glucose because of insulin resistance, meaning that glucose accumulates even more in their blood in times of stress.

Now it is clear that one of the reason of increase of sugar level in blood is stress and anxiety. When the complainant met an accident and he was admitted to the trauma centre with crushed injury of left elbow and forearm with crushed injury right forearm and hand due to fall from the train. In the case history of the complainant, the trauma centre has written in detail all the details and also showing the region of crushed area by diagram. The patient/complainant was a known case of diabetes but he did not bring all the pathological reports and treatment papers. The anaesthetist has written that patient has a random sugar of 279. He is known case of diabetes mellitus (DM) and was on OHA (Oral HypoglycaemicAgents). For two days he was not on any drug on insulin. It shows that no insulin was given to him but he was on oral medicines, so it is wrong to say by the complainant that the doctor did not take care of his diabetes. He was already asked to continue on his drugs which was being taken for the diabetes. His both the hands were crushed and it is a cause of stress and anxiety. We have seen earlier by the medical articles that stress and anxiety increase the level of sugar in blood. The random sugar 279 is not alarming.According to the University of Michigan, blood sugar levels of 300 mg/dL or more can be dangerous. They recommend calling a doctor if you have two readings in a row of 300 or more. Call your doctor if you're worried about any symptoms of high blood sugar. In trauma centre the random blood sugar was measured which came 279 which was not alarming because this level was due to stress and anxiety on account of injury. It could be controlled by the doctors of trauma centre who were competent to treat it. Complainant’s case was a case of compound fracture and dislocation of bones ,for which the treatment was started. Later on the complainant himself left the trauma centre . On 10.02.16 the patient was taken up for surgery and skeletal stabilisation was done which was necessary in this case. But on the subsequent day in the post-operative period the patient insisted for LAMA despite of all the prognosis explained.

The complainant was amputated in SIPS. As per report of the trauma centre, the lime of complainant was already infected due to injury as it was a crushed injury. Once there is crushed injury, chances of gangrene increases. In this case the doctors of the trauma centre first managed skeletal stabilisation.Bones provide the stability and skeletal framework to which the soft tissues are attached while joints offer mobility to the hand and limbs. When damaged severely as in crush injuries, the hand becomes flail and thus stabilization and repair of the skeleton has to be undertaken before soft tissue reconstruction proceeds. It is therefore essential that fracture fixation is adequately performed primarily and is strong enough to provide a stable scaffold to undertake further soft tissue repairs as well as undergo rehabilitation. The issue of internal versus external fixation is not so much of a dilemma in the upper limb as it is in the lower limb and decision-making is relatively straightforward. The upper extremity is blessed by a better blood supply and less infection. Grade IIIB and IIIC fractures are common but deserve respect and caution. Whether to use plates, screws or Kirschner wires depends on the amount of contamination, bone loss, soft-tissue defect, tendon system and rigidity desired. Of course, surgeon’s preference and the time factor play an important role too. There are now a compendium of internal fixation devices of which we find the low-profile variable angle locking plates very handy (

Figure 7.

A wide array of titanium low-profile plates of various sizes and shapes are now available to suit the hand surgeon’s and patient’s needs. Top left: the older miniplates. Left: the trilock mechanism—a neat way to get the screw head to lock in the plate. Middle: theMedartis® range—one of the most “low-profile” plates in the market with chamfered edges for both plates and screws. Right: theOsteomed® PIP and MCP fusion plates—a novel development.

Sometimes in severe comminution in the digits, closed pinning with cross K-wires has been found to be quite useful, since the intact periosteal sleeve provides support. Some surgeons believe, however, that K-wires cause “spot-welding” of tendons, especially on the dorsum of the hand, pinning down the extensor mechanism. Care should be taken in placement of these wires, which should preferably be buried under the skin and away from tendinous or ligamentous structures for ease of hand rehabilitation as well as reduction in infection rates (especially in tropical climes). They can be removed later if need be rather than earlier if they are subcutaneous.

Severe damage to the DIPJs is fairly well tolerated by fusion, but with the advent of the miniscrew (1.0 1 nd 1.2 mm), tiny fractures may be dealt with precisely. The hook plate by Medartis® tackles the difficult dorsal lip avulsion fracture beautifully; however, the sequence of performing the fixation is key and care should be taken not to injure the germinal matrix (

Basal metacarpal fractures may be stabilized by transverse K-wiring to maintain height unless it involves the ulnar base of the fifth metacarpal (attachment of the ADM), where fixation ensures no displacement (diaphyseal fractures, on the other hand, may require either intramedullary fixation or plates and screws. In spiral fractures, two interfragmentary screws or even cannulated microscrews (rotation of digits should be given special attention. Axial and especially rotational malalignment is magnified from proximal to distal starting at the metacarpal level, thus plating is a better option and little added time is necessary. Prevention is the key, by checking rotation after the fixation. The present minihand plates are lower in profile, chamfered (including the screws) and even locking, causing little interference to the tendons and providing the required rigidity. If there is a significant amount of bone loss, the normalization of length can be achieved by transfixing K-wires through the adjacent metacarpals and bone grafting the defect plus plating if the gap is up to 8 cm long (

Figure 8.

A: there is an avulsion fracture of the dorsal lip of the distal phalanx (P3) and the DIP joint is subluxedvolarly. B: a central 0.8-mm K-wire is inserted in to P3, the joint is reduced and C: the wire is pushed into the middle phalanx (P2). D: the approach is then made dorsally and the fracture fragment reduced to P3. An incision made in the germinal matrix prevents it from being compressed. E: the holding screw is inserted. F: final picture. G: a severely crushed P3 with mallet deformity requiring bony stability was fixed with a 1.0-mm miniscrew. H: postoperative film.

Figure 9.

A: intra-articular fracture of the radial condyle of P1 of the left MF. B, C: reduction and fixation with a 0.6-mm K-wire and a 0.4-mm cerclage wire. D, E: good grip and ROM—10–110°. F, G: a 23-year-old engineering student presented a month later with a volar lip fracture (P2) and dorsal dislocation of his R ring finger. H, I: through a volar approach, the two condylar fragments were reduced and held with K-wires before miniscrews were inserted. J: the volar plate was reattached with a bone anchor suture. At 3 months postoperation, he had a 20°-extension lag and full flexion.

Figure 10.

A, B: a die-punch type of pylon injury to the base of the middle phalanx (P2). The patient was not keen on surgery. C, D: overall view of the thermoplastic splint. E, F: close-up view. A strap was glued to the dorsal nail plate and traction applied. G, H: the fracture reduction as seen after 3 to 4 weeks.

Figure 11.

A: intra-articular fractures of the bases of the fourth and fifth metacarpals. B: a low-profile ladder plate from Medartis® is used to attain precise reduction. C: a cannulated screw and K-wires were only possible for the fifth base due to extensive comminution. D: another patient with basal fracture dislocation of the fifth metacarpal and CMC joint. E: the basal K-wire was used to reduce the fracture fragment, but it started to push it away, so the proximal K-wire was used to maintain height as well as push the fifth metacarpal toward the fourth and hold it in place. E, F: a square plate was applied on the dorsal surface straddling the joint with screws in the hamate to keep reduction and immobility. G, H: patient with a very distal fracture neck of the fifth metacarpal. I: the miniplate applied (1.5 mm Medartis® Aptus) allows a full hand grip without interfering with the tendon mechanism reducing fifth MCPJ stiffness.

Figure 12.

A: very comminuted fractures of the first and fifth metacarpals, while the second (B, C) was relatively amenable to minimal screw fixation because it was a long spiral. Four screws were required! D: a basal fracture of the fifth metacarpal with considerable comminution addressed by a cannulated screw (white arrow) and K-wires. E: similarly a single cannulated 2.2-mm screw (white arrow) correctly placed can tackle the volar beak fragment of the first metacarpal fracture.

So the treatment given was as per need and as per the medical profession and ethics. Now we come to the issue of gangrene. What Are the Gangrene Risk Factors?

Any condition that decreases your blood flow increases your chances of getting gangrene, including:

• Serious 

Now this is a case of crushed hand. When a crush injury cuts off circulation and oxygen supply to an area of the body, the cells in that area begin to die quickly. This can allow for gangrene and other bacterial infections to set in within hours. You may even risk developing sepsis, a potentially life-threatening infection of the blood.When a crush injury cuts off circulation and oxygen supply to an area of the body, the cells in that area begin to die quickly. This can allow for gangrene and other bacterial infections to set in within hours. You may even risk developing sepsis, a potentially life-threatening infection of the blood.

Lasting impacts of a crush injury can include amputation, nerve damage, and long recovery periods for infection. This can also cost you a lot in medication, hospital bills and lost wages, and these debts can potentially last for years after the initial incident that caused your injury. This is why many victims in your position choose to seek compensation, and why you may wish to consider it as well.

So from all the medical articles it has become clear that there was no deficiency of service or negligence on the part of the doctors of the trauma centre. All this was due to crushed hand of the complainant. Gangrene is common in such cases. When the part of the body has been crushed to so badly, it could not get supply of the blood which may result in gangrene. We have seen all the documents filed by the opposite parties regarding the treatment of the complainant. There was no medical negligence on the part of the trauma centre. The complainant wasn’t known case of diabetes and also a case of crushed injuries due to fall from a train. How did he fall from a train? He was being given proper treatment at trauma centre. We do not find any negligence on the part of the opposite parties.

ORDER

The complaint case is dismissed with costs.

The stenographer is requested to upload this order on the Website of this Commission today itself.

Certified copy of this judgment be provided to the parties as per rules.     

  (Vikas Saxena)                         (Rajendra Singh)

       Member                              Presiding Member

Judgment dated/typed signed by us and pronounced in the open court.

Consign to the Record Room.

  (Vikas Saxena)                                       (Rajendra Singh)

       Member                                            Presiding Member

Dated :    23 August, 2022

Jafri, PA II

C-2