Mahendra Bhagat Vs. Bhandari Hospital and Research Centre Through Its Director/Prop./ Manager and Others - Court Judgment

Ashok Parihar, President:

The complainant is working in Rajasthan Police Department. The first child baby Manisha was born on 16.9.2001 at Nagpur. It has been alleged that baby Manisha was under regular medical care of respondent no.3 Dr.Ashutosh Jindal working in respondent hospital. Initially four polio drops had already been given to baby Manisha two at Nagpur and subsequent two at Jaipur in respondent Hospital. The baby Manisha was taken to the respondent hospital on 10.8.02 due to sudden illness. Dr.Ashutosh Jindal prescribed injection of Keftra in addition to some other medicine. It has been alleged that due to intramuscular injection of Keftra given by Dr.Ashutosh Jindal himself sciatic nerve of the right lower limb was damaged resulting in sensory loss and foot drop. Since proper medical treatment was not given in the respondent hospital the baby was taken to SMS Hospital, Jaipur. The Neurologist Dr.Anjani Kumar Sharma in SMS Hospital,Jaipur after examining the baby on 28.9.02 gave the opinion that because of wrongful intramuscular injection which has damaged the sciatic nerve of the right leg of baby Manisha has led to creation of foot drop in the child. After report of Dr. Anjani Kumar Sharma a criminal complaint was lodged in the police against Dr. Ashutosh Jindal for offence u/s 269, 336 IPC. A medical opinion was also sought by the investigating agency from the medical board and subsequently a charge sheet u/s 269, 336, 338 IPC has already been filed against Dr. Ashutosh Jindal which is pending trial before the competent court. Alleging medical negligence a compensation of Rs. 37 lakhs has been claimed against the hospital and the doctor concerned.

In reply to the complaint it has been submitted on behalf of the respondents that baby Manisha was born on 16.9.2001 at Nagpur. However, she was brought to the respondent hospital for the first time only after three months i.e. on 15.12.2001 with a complaint of diarrhea. At the time of examination it was observed by Dr.Jindal that baby Manisha had low weight for a child born at full term.The intra-uterine growth of baby Manisha was also found to be poor and asymmetrical. It had also been observed from the record of baby Manisha that she had within one month of her birth suffered septicemia as well as hypoglycemia. It has also been submitted that the child was not given proper vaccination including administration of oral polio vaccine as per fixed norms. The first two polio drops were given to the baby on 15.10.01 and 30.11.01 at Nagpur itself. So far as respondent hospital is concerned third and fourth polio doses were given to the baby on 30.12.01 and 30.1.02 respectively.

It has further been submitted on behalf of the respondents that baby Manisha was brought to respondent hospital on 7.8.02 with a complaint of vomiting and abdominal pain. She was found to be suffering from acute colicky abdominal pain. The baby was admitted in the respondent hospital on 7.8.02 and after recovery she was discharged on 8.8.02. The baby was again brought to respondent hospital on 10.8.02 with the complaint of cold and vomiting. She was advised injection Perinorm and syrup Ondem and Cold Act Plus. When not recovered fully the baby was again brought to the respondent hospital on 10.8.02 itself. Dr. Ashutosh Jindal advised a broad spectrum efficacious antibiotic in the form of injection Keftra. The parents of the baby were advised to get her admitted in the hospital. However, not agreeing to the advise, the baby was taken to her home. It has further been emphatically denied by Dr. Ashutosh Jindal that the intramuscular injection of Keftra was ever given to the baby by himself or any of the staff members of the hospital. Accordingly, the allegations of deficiency of service so far as respondent hospital and Dr. Ashutosh Jindal have been refuted.

On behalf of the complainant affidavit of complainant has been filed alongwith the report of Dr. Anjani Kumar and the report of medical board of the SMS Hospital,Jaipur as well. The respondents submitted affidavits of Dr. Ashutosh Jindal and Dr.S.G.Kabra alongwith the report of a committee of three doctors headed by Dr.S.G.Kabra from Santokba Durlabhji Memorial Hospital, Jaipur.

Ms.Gesu Hora counsel for the complainant with all vehemence at her command while referring to certain medical reports published in various journals tried to support the allegations made by the complainant in regard to deficiency of service so far as Dr.Ashutosh Jindal and the respondent hospital are concerned.

Mr.Vizzy Agarwal counsel for the respondents with assistance of Dr.S.G.Kabra has submitted that alleged physical deficiency in the baby might have been developed only due to improper treatment given at Nagpur. Sufficient care had been taken at the respondent hospital specially by Dr.Ashutosh Jindal. It has been submitted that injection of Keftra was never given by Dr. Jindal or any of his nursing staff to baby Manisha on 10.8.02. No proof in this regard has been submitted by the complainant so far. Even if the injection Keftra would have given to the baby causing alleged injury of sciatic nerve, then the baby would have felt excruciating pain within an hour of the administration of the injection itself. However, no such pain was reported for four days. It was only when the parents noticed a little right foot drop and baby Manisha had taken the thumb of right foot in her mouth causing serious injury, the baby was shown to Dr. Jindal who after examining the baby found that she had developed distal/ terminal paucity of movement in her right lower limb mostly foot. However, that in no case can be attributed to the alleged intramuscular injection of Keftra which otherwise was not given by Dr.Jindal or any of the nursing staff of the respondent Hospital.

After having considered the submissions of counsel for the parties, we have carefully gone through the material on record.

It may be noted on the very onset that in the present case we are not concerned with the technical details of a particular disease or cause of the same. We have only to decide whether there was any medical negligence or deficiency of service so far as Dr. Ashutosh Jindal and respondent hospital are concerned resulting in alleged physical deficiency in the baby. As has already been observed above, it has been alleged that the baby suffered because of intramuscular injection of Keftra given by Dr.Ashutosh Jindal causing damage to the sciatic nerve. In view of the emphatical denial by Dr. Ashutosh Jindal that the alleged injection so was prescribed by Dr.Jindal was never given by Dr.Jindal himself or any of his nursing staff in the respondent hospital, the burden was on the complainant to prove the allegation. However, neither any bill of purchase of the injection nor receipt of the hospital has been submitted by the complainant to support the allegation.

Without referring to the reports of Dr.Anjani Kumar Sharma as also medical board of the SMS Hospital, Jaipur we would like to quote the relevant report given by the committee of three eminent doctors of Santokba Durlabhji Memorial Hospital, Jaipur including Dr. Suresh Gupta, Consultant Neurologist, Dr. Ramji Narayanan, Consultant Surgeon and Dr.S.G.Kabra , Ex. Prof. Of Anatomy, SMS Medical College, Jaipur which is quoted as under: -

“We find serious flaws in the report of this medical board and disagree with the conclusions they have drawn. Our reasons are as follows:

1. There is no record of severe pain at the injection site immediately after the injection was administered to suggest that the injection damaged the sciatic nerve.

2. There is a time lag of 4 days between the injection and the onset of paralysis which is incompatible with paralysis due to a wrongly administered injection. Post- injection paralysis would be immediate as the noxious insult acts rapidly.

3. The notes by Dr. Anjani do not mention objective sensory loss ( which is expected in a sciatic nerve injury ). The details of the site of paralysis ( muscle groups involved ) and degree of paralysis are not mentioned. Dr. Anjani does not categorically say that the paralysis was due to injection but only raises the possibility ( there is a question mark placed before this diagnosis in his notes).

4. The Medical Board found no foot drop on the right side but only paralysis of the illio-psoas and quadriceps muscles in the right lower limb. None of these muscles are supplied by the sciatic nerve. The nerve supplied to the quadriceps muscle is in the groin and that of the illiopsoas is in the abdomen and both sites are qell away from the alleged injection site.

The findings of the Medical Board consequent to its examination of the child are contrary to the nerve conduction report that suggests a common peroneal – posterior tibial involvement of the right side.The medical board found no foot drop or calf weakness ( the presence of which would imply these nerves ) on the right side. On the other hand, the medical board found weakness of the tibialis anterior and extensor hallucis iongus of the left lower limb ( not the side of the injection ).

For the medical board, therefore, to even suggest that part of the picture was due to an injection is totally at variance with their own clinical findings. Their findings support a diagnosis of a condition that has affected the quadriceps and illiospoas muscles of the right leg and the quadriceps tibialis anterior and extensor hallucis iongus muscles of the left leg. An allegedly incorrect intramuscular injection into the right gluteal region cannot produce such a picture.

5. Regarding the nerve connduction study report showing changes in the right common peroneal nerve and right posterior tibial nerve, the changes are consistent with poliomyetitis. When the muscles supplied by the common peroneal nerve can be affected on the left side ( where an injection was not given ) by poliomyetitis, there is no reason to attribute such a nerve lesion on the right side to a cause other than poliomyetitis.

6. In his complaint, the complainant has alleged serious handicape as a result of the intramuscular injection. This is a wholly erroneous conclusion and does not stand up to rational medical scrutiny. As per the findings of the Medical Board and based on what we have tried to explain, the child's present handicaps are entirely due to weakness of muscles which are in no way supplied by the right sciatic nerve. To conclude, therefore, we believe that Miss Manisha suffered from poliomyetitis which has left her handicapped. The submission by the complainant that she is handicapped because of intramuscular injection into the right gluteal region is incorrect.”

No counter report so far has been submitted on behalf of the complainant. From the report as quoted above it can be easily inferred that there has been no medical negligence or deficiency of service so far as Dr.Ashutosh Jindal and the respondent hospital are concerned. At this point we may also observe that the criminal case as referred above is already pending trial before the competent court. However, so far as present complaint before this Commission is concerned, the complainant has failed to prove any medical negligence or deficiency of service so far as Dr.Ashutosh Jindal and respondent hospital are concerned.

Accordingly, we find no merits in the complaint and the same is dismissed with no order as to costs.