Case Study

Amputation of Leg – Held No Negligence of Doctor

St. Stephen Hospital v. Dhani Ram


Facts: The complainant Dhani Ram about 18 years of age, met with road accident on 23.4.1998 and suffered severe injuries to his left leg.  He was admitted in emergency ward of the OP/Hospital.  During the intervening night of 23/24.4.1998, he was hospitalized, remained under treatment till 11.6.1998 and discharged.  After discharge, he was under regular follow up with the OP/hospital and under medication for relief of wounds sustained to his left leg.  The treatment was continued till 5.7.1998 but the patient and his family members were not satisfied as the pain and bleeding in the wounds of left leg was continued.  Therefore, he was taken to AIIMS on 6.7.1998, where he was immediately admitted and he was told by the doctors that he was not properly treated at St. Stephen Hospital.  Accordingly, his left leg was amputated on 6.7.1998 itself and he was discharged from AIIMS on 11.8.1998.  Thereafter, he was under regular follow up treatment till July 2000 for which he had spent approximately Rs. 1.5 lakhs.  The complainant alleged that due to negligence of OP/hospital, he lost his left leg, suffered mental agony and he became dependent on others.  The complainant filed a complaint before the State Commission on 24.10.2001 for compensation.

Defence: The OP submitted that the complaint is time barred.  As, the patient was hospitalized from 24.4.1998 to 11.6.1998 and thereafter his left leg was amputated at AIIMS on 6.7.1998.  The complaint was filed on 24.10.2001, it was filed after two years of cause of action, hence, time barred.  The OP also took a ground that AIIMS was one of the necessary parties, therefore, the complaint is bad for mis-joinder of the necessary party.  OP further submitted that due to road accident, the patient suffered vascular injury to Popliteal artery.  The pheripheral pulses were absent, therefore, performed angiogram and exploration of Popliteal artery with embolectomy.  On 15.5.1998, the patient underwent surgery and external fixator was applied for fracture and administered proper doses of Heparin.  The development of gangrene in left foot, was a direct outcome of injuries sustained by the patient.  Despite proper care, there was darkening of toes and the same was informed to the patient and his relatives and also cautioned about amputation at some stage might have to take place.  It was a dry gangrene.  It was advised to wait for salvage of the limb, and immediate surgery was not necessary.  The patient was advised for daily follow up and dressing of wounds but the patient did not turn up for the best reasons known to him.  Even the records of AIIMS also did not mention about any negligence in the treatment given by St. Stephen Hospital.  The OP further submitted that father of complainant was informed about injury which he in his own handwriting wrote in the case-sheet of the patient.  Thus, there was no negligence on behalf of the doctor or on the part of hospital.  The patient was treated with the normal standard of practice.  Dr. Mathew Varghese had treated the patient, who was the Head of Department and having vast experience with lot of publications on his credit.  He has taken utmost care while treating the patient.  The patient and his father were informed about injury, the possible complications and also about the need for amputation.  Before amputation, the first priority was to salvage the limb and the presence of zone of demarcation is necessary before taking decision of amputation.   In view of salvage, Dr. Varghese performed angiography of Popliteal artery, which is a major artery supplying the foot.    Embolectomy was performed and periodic Heparin injections were given.  The State Commission allowed the complaint and directed the OP to pay Rs.2 lakh to the complainant.

Standard text relied upon: Medical literature regarding treatment of gangrene from Biiley & Love’s SHORT PRACTICE OF SURGERY under Chapter Arterial Disorders: “Treatment of gangrene “A limb-saving attitude is needed in most cases of symptomatic gangrene affecting hands and feet.  The surgeon is concerned with how much can be preserved or salvaged.  With atterial disease, all depends upon there being a good blood supply to the limb above the gangrene, or whether a poor blood supply can be improved by such measures as percutaneous translumral angioplasty or direct atterial surgery.  A good or improved blood supply indicates that a conservative excision is likely to be successful and a major amputation may be avoided.  A life-saving amputation is required for abadly crushed limb, rapidly spreading symptomatic gangrene and gas gangrene.”
Observations: I have perused the medical record and the evidence on the file, also gone through textbook of Vascular surgery and Campbell’s Orthopaedics.  The medical record clearly revealed that the patient suffered multiple injuries, abrasions and fracture also.  The OP/hospital treated the patient as per standard of orthopaedic norms.  The wound was necessary to be dressed daily but the patient failed to attend the dressing for regular interval. From the medical record, it is proved that at initial stage of treatment, the OP/Dr. Varghese performed Popliteal artery exploration after angiography.  At the time of discharge, the wound was dry and there was no line of separation between normal and gangrenous part.  Hence, the amputation was not advisable at that time, which was later on performed in AIIMS

Held: There was no negligence on the part of treating doctor or the hospital.  I set aside the order passed by the State Commission and allow the first appeal.

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