KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM.

APPEAL  NO: 337/2006

 JUDGMENT DATED: 08-04-2011

PRESENT

JUSTICE SHRI. K.R. UDAYABHANU              :  PRESIDENT

SHRI.S. CHANDRAMOHAN NAIR                             : MEMBER

The Secretary,

AKG Memorial Co-operative Hospital,              : APPELLANT

Talap, Kannur – 2.

(By Adv: Sri.V.Ramkumar Nambiar)

          Vs.

1.      M.M. Sushmitha,

Puthiyavalappil, Kilaloor,

P.O.Bavode, Kannur District.

                                                                   : RESPONDENTS

2.      Dr.G.N.Suresh,

Skin Specialist, AKG Hospital,

Kannur – 2.

(By Adv.Sri.S.Reghukumar)

                                                JUDGMENT

JUSTICE SHRI.K.R. UDAYABHANU : PRESIDENT

The appellant is the 2^nd opposite party in OP.254/02 in the file of CDRF, Kannur.  The appellants are under orders to pay a sum of Rs.1.lakh as compensation and cost of Rs.2000/-. 

2.      The case of the complainant is that on 13/10/2000 she consulted at the 2^nd opposite party hospital for removal of a wart on the thumb of her left hand.  On 17-10-2000 the 1^st opposite party, skin specialist administered an injection on the thumb of her left hand.  She felt severe pain, thereafter certain medicines were prescribed.  As pain persisted after two days ie on 9/10/2000 she again approached the 1^st opposite party and again medicines were prescribed.  On 22/10/2000 she had temperature also and hence she was admitted as an inpatient. There was swelling on her left hand and the pain was unbearable.  She could not move the hand.   At the insistence of the complainant’s relatives on 27/10/2000 she was referred to KMC Hospital, Manipal and therein on 28/10/2000 a surgery was done on the effected portion.  Skin grafting was also done.  She was discharged on 14/11/2000.  She was a beedi roller by profession.  She has totally lost the mobility of her left thumb and is unable to engage in the above profession.  It is alleged that the suffering was the consequences of the treatment administered at the opposite party hospital.

3.      The opposite parties have filed version denying the allegation of negligence.  It is stated that the 1^st opposite party/skin specialist on examination found that the removal of the wart required electric cauterisation under local anesthesia.  Before starting the procedure it was found that the complainant had a history of previous surgery a few months back under spinal anesthesia.  Local anesthetic, injection-Xylocaine 2% was administered and she experienced severe pain and immediately the 1^st opposite party stopped giving the injection.  Usually, the pain used to be subsided after some time.  The 1^st opposite party abandoned the procedure.  Analgesics and anti inflammatory drugs were prescribed for 2 days.  On 19/10/2000 she reported with mild pain and small discoluarisation at the site of injection.  Thereafter the 1^st opposite party prescribed anti oxidants, cap. Selace. On 23/10/2000 she again reported with pain and swelling.  There was some black disclouration with swelling.  She was immediately referred to the surgeon.  She was admitted and antibiotic injections were administered ie injection gentamycin.  As there was no improvement, she was referred to KMC hospital, Manipal for expert management.  It is contended that the complainant had developed a condition called Nicolau syndrome following the injection of the local anesthesia.  She developed arterial vasospasm and cautaneous necrosis which can happen even after doing sensitivity test.   The excruciating pain she experienced after injection was due to the peculiar behaviour of the complainants body resulting in the above condition.  The treatment is only of supporting nature.  Surgical intervention is indicated only when the gangrinous portion was demarcated and this would take some time.  As she did not show much improvement, she was immediately referred to a higher centre.  It is denied that her arm has become disfigured and that there is no mobility etc.  It is the contention that the reaction of the body of the complainant to the injection was beyond the control of the 1^st opposite party.

4.      The evidence adduced consisted of the testimony of PW1, DWs1 to 3, Exts.A1 to A18 and B1 to B6.

5.      DW1 is the Chief Executive Officer of the 2^nd opposite party hospital,  DW2 is a skin specialist attached to the hospital and DW3 is the surgeon attached to the 2^nd opposite party hospital who also had treated the complainant.  The 1^st opposite party/skin specialist did not testify. It is stated that he is working abroad and hence not available.  DW2, the skin specialist has not treated the complainant.  He has stated that Nicolau Syndrome is a condition of body that certain persons are having and that the same cannot be predicted or found out in the sensitivity test and that the exact reason for the same is not known.  According to him there was no negligence on the part of the 1^st opposite party doctor.  He has stated in cross-examination that the removal of wart is a minor surgery.  He could not say whether any test dose was given.  DW3, the surgeon has also testified in some manner.  According to him even if test dose was given the complication can develop in the persons whose body condition is such that they are having proclivity of Nicolaus Syndrome.

6.      It is seen from the records produced that the complainant was an inpatient of the 2^nd opposite party hospital from 23/10/2000 to 26/10/2000 ie for 4 days. On 27/10/2000 she was admitted at the Manipal hospital.  On 28/10/2000 she underwent surgery under general anesthesia.   Pedicle grafting was done on her left thumb.  In Ext.A2/B6 reference letter issued from the 2^nd opposite party hospital, it is mentioned that the complainant developed cellulitis after administration of Xylocaine 1%.  We find that as per Ext.B1 case sheet of the opposite party hospital injection of Xylocaine 2% is mentioned.  It appears there was an attempt to reduce the strength of the medicine in Ext.A2/B6 reference letter. In Ext.A6 discharge summary from the Manipal hospital it is mentioned that the complainant was having a large dense blister over dorsal aspect of base of left thumb and skin around the blister was dark in colour.  As per Ext.A7 Physical Assessment Certificate from the Department of Physical Therapy of Manipal Hospital dated:15/12/2011 it is mentioned that she cannot do the work of beedi rolling she cannot do cooking and she cannot hold large object like glass.  There was no mobility to the left thumb.  The Forum has also noted that even at the time of her deposing before the Forum the finger is not capable of moving and the same was disfigured.  

7.      As pointed out by the counsel for the complainant Nicolau Syndrome is not mentioned anywhere in the case sheets, either of the opposite party hospital or that of Manipal hospital.  There is no mention of having given test dose in Ext.B1 case sheet of the opposite party hospital.  It is virtually admitted that test dose was not given.  It is the case of the opposite parties that even if test dose is given it would not be possible to avoid the complications of Nicolau Syndrome.  No medical literature was produced by either side as to whether Xylocaine injection can cause such a reaction or that by administering test dose the complication could have been avoided.  So, also in order to support the contention of the opposite parties that even if test dose was given Nicolau Syndrome could not have been avoided no literature was produced.   Evidently there is lapse on the part of the 1^st opposite party doctor in not administering test dose.  It is common knowledge that allergy to drugs can develop at any time.  The fact that the complainant had a surgery under spinal anesthesia a few months back is no reason to avoid the test dose.  As noted by the Forum, the complainant has undergone severe pain and also a surgery under general anesthesia that included skin grafting.  She is till having disabilities.  The complainant was aged only 26 years and is a lady, she has spent considerable amount for treatment at a far off place from her residence.  Lapse on the part of the 1^st opposite party doctor to administer test dose is a serious lapse and the above action amounts to negligence.  (See Dr.Kaligounden Vs. N.Thangamuthu, III (2004) CPJ 29 (NC).  The fact that he has not deposed is also relevant.  The complaint has been filed on 10/10/2002 and disposed only on 3/3/2006.  The omission on the part of the 1^st opposite party to depose is quite material Savita Garg (Smt) Vs. Director, National Heart Institute (2004)8 SCC 56 .

8.      In the circumstances we find that the compensation ordered ie Rs.1.lakh is not excessive e.  It has also to be noted the Forum has not awarded any interest to be paid.   The order of the Forum is sustained.  Opposite parties/appellants are directed to pay the amount of Rs.1.lakh with interest at 8% from the date of the order of the Forum ie 3/3/2006.  The direction to pay cost of Rs.2000/- is sustained. The opposite parties are directed to make payment within 3 months from the date of receipt of the copy of this order failing which the complainant will be entitled for interest at 12% from the date of this order of this Commission.

The office will forward the LCR along with the copy of this order to the Forum.

JUSTICE K.R. UDAYABHANU:  PRESIDENT

S. CHANDRAMOHAN NAIR : MEMBER

VL.