Case Study

DUE CARE AND STANDARD PROCEDURE

Bishakha Ghosal v. Barrackpore Medicare & Recovery Center Ltd. & Anr., Decided by National Consumer Disputes Redressal Commission, New Delhi On 11.04.2019


Facts: The complainant met with a motorbike road accident on 09.08.2013 and she was taken to Barrackpore Medicare & Recovery Centre Ltd. – the opposite party no. 2. Dr. Nirmalya Basu (opposite party no. 1), an Orthopaedic Surgeon examined the patient and x-ray showed fracture of shaft of humerus –left side.  On 11.08.2013, the opposite party no. 1 performed surgery i.e. Open Reduction Internal Fixation (ORIF) with Dynamic Compression Plate (DCP).  Thereafter, due to radial nerve compression, patient suffered some neural problem and it was diagnosed as ‘Axonal type’ of neuropathy (sensory + motor) of left radial nerve.  Therefore, on 14.08.2013 to release the compression of radial nerve between soft tissue and the plate, second operation was performed by opposite party no. 1 and plate was re-positioned.  Even then, patient had continuous pain in her left hand and there was serosanguinaous discharge with obnoxious smell.  Despite regular dressing, there was no satisfactory result.  On 30.08.2013, the patient approached the treating doctor, who advised to use shoulder immobilizer and dynamic cock up splint.  Patient was also advised for active and passive finger exercise but due to finger swelling, the patient was unable to move his fingers.  The patient was feeling current like sensation, therefore, approached opposite party no. 1 04.10.2013.  The X-ray showed loosening of the screw.  The opposite party no. 1 advised for Faradic Nerve stimulation of radial nerve and assured that the nerve recovery would be complete within short time.  On 08.11.2013 another X-ray was taken which revealed Osteocoolysis.  Therefore, the opposite party No. 1 referred the patient to Dr. S. Mishra at Columbia Asia Hospital for further treatment wherein the diagnosis of ‘infected non-union of fracture shaft humerus was made and patient underwent treatment from Dr. Mishra in two stages to avoid total damage to her hand.

Observations: Admittedly the complainant – patient due to road traffic accident suffered severe injury and fracture to her left hand – shaft humerus.  It was a compound fracture i.e. fracture of bone with injury to soft tissue and muscle also.  The opposite party doctor after initial treatment performed surgery (ORIF with DCP of left radius).  However, complainant has no grouse against the operation.  On perusal of medical record, we note that there was left radial nerve compression because of the plate (DCP) and soft tissue.  The opposite party No. 1 performed second surgery for decompression to release pressure on the radial nerve. However, the nerve was intact and there was no damage. Thereafter, the OP-1 re-examined the patient on 08.11.2013 and found that the fixed plate was progressively getting loosened.  It was an indication of deep seated infection.  Therefore, patient was referred to an expert Dr. Soumitra Mishra, who diagnosed it as infected non-union of fracture.  It should be borne in mind that, mere infection during the post-operative period is not only due to negligence of the treating doctor.  There are several factors for infection of surgical wound.  It is pertinent to note that after surgery and during entire treatment, patient was put on regular dressing and antibiotics; despite that there was infection.  Moreover, as per the evidence on record, opposite party no. 2 hospital is having all diagnostic facilities and competent doctors.

Standard Text:    To know more about Radial Nerve Palsy, we have gone through the medical text from the Campbell’s Operative Orthopedics (11th edition).  Accordingly it is that:

“The radial nerve is the nerve most frequently injured with fractures of the humeral shaft because of its spiral course across the back of the midshaft of the bone and its relatively fixed position in the distal arm as it penetrates the lateral intermuscular septum anteriorly.  Usually the radial nerve injury is a neurapraxia, with recovery rates of 100% in low-energy injuries and 33% in high energy injuries.”

Held:   On the basis of foregoing discussion, in our view, it was low-energy injury causing neurapraxia not a radial nerve palsy.  The treating doctor (OP-1) was an orthopedic surgeon, had performed his duty to the best of his abilities and with the due care and as per standard procedure.  In our view, the complainant failed to prove negligence on the part of the opposite party hospital and the treating doctor.

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