DISTRICT CONSUMER DISPUTES REDRESSAL FORUM PALAKKAD
Dated this the 12th day of April 2017
Present : Smt.Shiny.P.R. President
: Smt.Suma.K.P. Member Date of filing: 15/12/2015
: Sri.V.P.Anantha Narayanan, Member
(C.C.No.192/2015)
1.Aparna
D/o.Rajagopalan,
Kottarattil, Ongallur,
Kalladipatta Post,
Perokkur Desom, Pattambi
(Rep.by her mother Radhika)
2.Radhika.
W/o.Rajagopalan,
Kottarattil, Ongallur,
Kalladipatta Post,
Perokkur Desom, Pattambi - Complainants
(By Adv.Binoy.T.M.)
V/s
Managing Director
Nila Hopital
Pattambi,
Palakkad - Opposite party
(By Adv.V.K.Venugopalan)
O R D E R
By Smt.Shiny.P.R. President.
Brief facts of complaint are that due to the severe abdominal pain to the 1st complainant, on 19/2/2015, the 2nd complainant along with her neighbour has brought the 1st complainant her daughter to opposite party Hospital. The doctor in charge of causality has examined the 1st complainant and prescribed an injection named ‘Relievio’ a tablet named as ‘mefset’ and instructed for urine test. The nursing staff of the hospital has injected the medicine on right leg of the patient.
After half an hour of the injection taken, 1st complainant had suffering from numbness and itches over right leg. On the arrival of the complainants to the home, 1st complainant could not walk and lost the sensation of the right leg. Complainants further submitted that till now she could not walk without other’s help.
On 20/2/2015 the complainants approached the opposite party. Dr.Suresh kumar, Paediatrician after discussion with Ortho Surgeon, has suggested to consult a Neuro Surgeon. Then complainant has consulted Dr.S.Siva Subramanyam, Consultant Surgeon, Sevena Hospital, Pattambi, Dr.Srikumar, Consultant, Child Neurologist, Centre for Epilepsy and Neurology, Calicut, Prof.P.C.Gilvaz, Consultant, Neurologist, Jubilee Mission Medical College, Thrissur, Dr.Davis Mannual, Neurologist, PK Das Institute of Science, Vaniyamkulam, Ottapalam and Neurology Unit, Govt.Medical College Hospital, Thrissur.
Neurologists opinioned that the decease is common perennial paralyze due to the injury happened to the sciatic nerve and the sciatic nerve has got injury by the reason of the injection contacted to sciatic nerve.
Opposite party submitted that the above mentioned damage has happened only by the reason of the gross negligence on the part of nursing staff of opposite party hospital. The opposite party has committed the deficiency of service. The opposite party has the liability to compensate the complainant and complainant is entitled for Rs.20,00,000/- as damages from the opposite party.
Complaint was admitted and issued notice to opposite party. Opposite party filed version contending the following:
Opposite party admitted that on 19/2/2015 at 1.30 pm first complainant was brought to the causality in the opposite party hospital at 1.30 pm on 19/2/2015 and consulted the causality medical officer with complaints of pain in right iliac fossa. The causality medical officer had examined the patient. She was diagnosed to have ureteric colic and prescribed Inj.Relivo (Diclofenac) in aqueous from ½ cc as intra muscular (IM) and tab Mefazest and advised urine routine examination. The causality duty nurse had taken intra muscular injection at Ventro-gluteal site with due care and caution and the patient got relief and she was sent home with prescription of medicines.
On 20/2/2015 the patient reported back to the hospital and consulted the paediatrician with complaint of pain in the thigh and the paediatrician advised neurology consultation on suspicion of sciatic neuropathy. The first complainant did not turn up again and lost further follow up.
The sciatic neuropathy is not caused due to any negligence or carelessness on the part of the nursing staff in the hospital. The causality duty nurse who had administered injection is a qualified and experienced nursing staff in the hospital who had taken all precautions in the administration of intra muscular injection. The medication prescribed by the causality medical officer is the standard prescription for the diagnosed clinical condition of the patient and inj.diclofenac is administered in ventro-gluteal site being the medically accepted site of intra muscular injection.
As per anatomical presentation the sciatic nerve originates from the L4 through S3 nerve roots in the inner wall of the pelvis and then passes under the piriformis muscle, out of the pelvis into the buttock and through the greater sciatic foramen (sciatic notch) The nerve continues under the gluteus maximus muscle close to the posterior capsule of the hip joint, deep in the posterior thigh, where motor branches innervate the hamstring muscles. Although the sciatic nerve branches in the distal thigh the nerve fibers within the proximal main nerve trunk are arranged topographically. Those fibers are destined to become the common peroneal nerve arranged as discrete fascicle on the outside (lateral) aspect of the sciatic nerve, where they are more predisposed to compression and injury. Consequently, proximal sciatic nerve injuries can be difficult to distinguish from common peroneal nerve injuries without detailed electrophysiological and radiological assessment. Hence, it is most probably due to the peculiar anatomical presentation of the sciatic nerve in the patient, she was prone to the complication of intra muscular injection despite due care and caution exercised in its administration in ventero-gluteal region.
Injury can either be due to needle contact or due to nerve irritation caused by the medication which is possible even if injection is administered on front middle portion of the thigh or in ventro-gluteal area which are the medically preferred sites for intra muscular injections. The denial of the pathological aspects and the modern medicine, in the affidavit it is against ordinary prudence. It may be due to lack of knowledge in the subject matter.
Sciatic neuropathy is a medically accepted complication in intra muscular injection despite due care and attention taken in its administration. The causality nursing staff had taken all possible care and precautions and she is well justified in preferring ventero-gluteal site for intra muscular injection.
The patient developed alleged complication solely due to factors beyond the control of the said nursing staff for the well accepted medical fact that sciatic neuropathy can also be caused due to the nerve irritation / inflammation caused by medicines even without injury largely attributable to peculiar anatomical presentation of the sciatic nerve in the patient which cannot be ascertained before administration of medicines. The first complainant was treated in hospital as per accepted medical practice and protocol and there was no negligence or deficiency in service on the part of the doctor or nursing staff and hence the hospital is not vicariously liable to compensate the complainants.
The allegation that injection was taken on a wrong spot is unfounded. It is for the complainant to prove the same. It is also to be proved by medical experts that the first complainant developed any sought of disability or deformity due to the injection.
There are no deficiency in service on the part of the hospital and the staff. The hospital is not liable to compensate the complainant. They also stated that in their opinion the complainant has been fully cured of the defect and she is physically fit.
Both parties filed their respective chief affidavit. Ext A1 to A21 were marked from the side of the complainant. Ext.B1 series marked from the side of the opposite party. 2nd complainant was examined as PW1. Opposite party was examined as DW1
The following issues are considered
1.Whether there is any deficiency in service on the part of opposite party?
2.If so, what is the relief?
Issues 1 & 2
Both parties heard. We have perused the documents filed before the Forum. Allegation of the complainant is that without due care and caution nursing staff of the opposite party administered injection to the 1st complainant and due to the lack and care of the nursing staff 1st complainant could not walk and lost the sensation of the right leg and till now she could not walk without other’s help. Opposite party admitted the fact that on 19-2-2015 1st complainant was brought to the opposite party hospital and causality medical officer had examined the complainant and prescribed Inj.Relivo (Diclofenac) and causality duty nurse had taken intra muscular injection at Ventro-gluteal site.
After administering the injection 1st complainant has occurred sciatic nerve injury is an admitted fact. Admitted facts need not be proved. Opposite party contended that alleged complication developed solely due to factors beyond the control of the said nursing staff for the well accepted medical fact that sciatic neuropathy can also be caused due to the nerve irritation / inflammation caused by medicines even without injury largely attributable to peculiar anatomical presentation of the sciatic nerve in the patient which cannot be ascertained before administration of medicines. To establish this aspect opposite party did not adduce any evidence or produce any literature before the forum. Opposite party further contended that after consultation with the doctor on 20/2/2015 the first complainant did not turn up again and lost further follow up. This statement cannot be taken into consideration because Ext.A5 shows that on 20/2/2015 and 24/2/2015 the patient consulted the doctor for the same.
Contention of the opposite party is that causality duty nurse who had administered injection is a qualified and experienced nursing staff in the hospital who had taken all precautions in the administration of intra muscular injection. In order to prove the qualification and experience of duty nurse opposite party did not produce any document before the forum. Under the above discussions we are of the view that duty nurse of the opposite party committed negligence in her duty.
It is well settled that it is the complainant who is to carry the ball in proving his case. However, when she proves on record some prima facie evidence, the onus shifts on to the opposite party. Ext A7 shows that the 1st complainant has consulted Dr. S. Siva Subramanyam on 24-2-2015 and the said doctor endorsed on the back side of the prescription that the patient has sciatic injury due to intramuscular injection. On the perusal of Ext A12 dated 17-3-2015 it is revealed that NCS suggestive of motor and sensory axonopathy involving right common peroneal nerve. Ext A.20 shows that there is mild improvement compared to the study done on 17-3-2015. Documents produced from the side of the complainant shows that 1st complainant has taken treatment up to 20-9-2015. After perusing these documents we are of the view that complainant proved their case. Then the Onus of proof shifts on to the opposite party to explain as to why did the sciatic nerve injury happened to 1st complainant. The opposite party failed to rebut the evidence adduced by the complainants. In the above circumstances we are of the view that duty nurse committed negligence in her duty and administered injection without due care and caution. Therefore opposite party hospital is vicariously liable for the acts of their duty nurse.
In order to fix the quantum of compensation we evaluate the Ext A.21 report which shows that no pathology detected in MR evaluation of hip joints, no pathology detected along the course of right sciatic nerve and common peroneal nerve and no evidence of enlargement/T2 hyperintensity of common peroneal nerve at the location of knee (fibular head level). This reveals that 1st complainant has no disability. More over complainant did not produce either disability certificate or latest treatment records to show that the treatment is still continuing before the forum. However complainant is to be compensated for the pain and sufferings caused for seven months due to the negligent act of the nursing staff of the opposite party.
We, therefore hold that due care was not taken at the time of administering the injection which ultimately resulted in sciatic nerve injury. This clearly constitutes medical negligence and deficiency in service. Hence the complaint is partly allowed. Opposite party being the employer is vicariously liable for the negligence committed by the nursing staff working in the hospital. Hence we direct opposite party to pay compensation of Rs.25,000/- (Rupees Twenty five thousand only) together with 9% interest per annum from the date of filing of complaint till payment and Rs.5,000/- (Rupees Five thousand only) towards cost of proceedings.
Pronounced in the open court on this the 12th day of April 2017.
Sd/-
Shiny.P.R.
President
Sd/-
Suma.K.P.
Member
Sd/-
V.P.Anantha Narayanan
Member
Appendix
Exhibits marked on the side of complainant
Ext.A1 – Prescription dated 19/2/15 Nila hospital Pattambi
Ext.A2 - Prescription dated 19/2/15 Nila hospital Pattambi
Ext.A3 – Bill dated 19/2/15 issued by Nila Hospital, Pattambi
Ext.A4 - Prescription dated 19/2/15 Dr.C.Preetha
Ext.A5 – Prescription dated 20/5/15 of Dr.A.M.Sureshkumar
Ext.A6 – Prescription dated 24/2/15 of Dr.K.Venugopalan
Ext.A7 – Prescription dated 24/2/15 of Dr.Sivasubramanian
Ext.A8 –Outpatient cash bill dated 26/2/15 of PK Das Medical Institute
Ext.A9 – Prescription dated 2/3/2015 of Sevana Hospital
Ext.A10 – Prescription dated 3/3/15 of Govt.Medical College Thrissur
Ext.A11 – Prescription dated 10/3/15 of Sevena Hospital
Ext.A12 – NCS report dated 17/3/15 of Dr.Sreekumar
Ext.A13 –MNC report (4 nos) dated 17/3/15 of Dr.Srikumar
Ext.A14 – Prescription dated 17/3/15 of Dr.Srikumar
Ext.A15 –Patient Data Sheet (Epilepsy) dated 1/3/2015
Ext.A16 – Prescription dated 18/3/15 of Sevana Hospital
Ext.A17 –Prescription dated 4/5/15 of Sevana Hospital
Ext.A18 – Prescription dated 3/6/15 of Prof.Dr.P.C Gilvaz
Ext.A19 – OP Prescription dated 15/7/15 of Jubilee Mission Medical College, Thrissur
Ext.A20 – Patient summary dated 10/9/15 of PK Das Institute of Medical Sciences,
Vaniyamkulam
Ext/A21 – Scaning Report dated 20/9/2015 of Dr.Abraham Sebastian
Witness examined on the side of complainant
PW1 – Radhika
Exhibits marked on the side of Opposite parties
Ext.B1series –Photocopy of Outpatient record of Nila Hospital Pvt.Ltd.
Witness examined on the side of opposite parties
DW1 – Kunhali
Cost
Rs.5,000/- as cost of the proceedings
