MANIK ALIAS GANGAJIRAO ZUGARA MORE GULMOHAR SHRINAGAR Vs. RAJASTHANI & GUJRATHI CHARITABLE FOUNDATIONS POONA HOSPITAL AND RESEARCH CENTRE

JUDGEMENT

(1.) Complainant- Manik alias Gangajirao Zugara More has filed this complaint against Rajasthani & Gujrathi Charitable Foundations Poona Hospital and Research Centre-O.P.No.1 and also against Port Trust Hospital, Wadala, Mumbai-O.P.No.2 alleging medical negligence on their part in respect of treatment given by both hospitals to his son-Mahendra More.

(2.) According to the complainant, Mahendra slipped off his motorcycle on Sinhagad Road at about 10.30 p.m. on 23/02/1997. One passerby took him to Madhukar Hospital on Sinhagad Road and since his son has having head injury, he was brought to Poona Hospital/O.P.No.1 and admitted in the said hospital. He was admitted in Intensive Care Unit (I.C.U.) of O.P.No.1 and necessary treatment was given. According to the complainant, his relative used to wait day and night outside I.C.U. to monitor the health of Mahendra. Necessary medicines, injections and equipments were brought. His son was on endotracheal tube, which was inserted as he was in respiratory distress. Endotracheal tube was replaced by tracheostomy on 26/02/1997. C.T. Scan of the brain was taken. X-ray of cervical spine was taken. Cathedral was used for urine passage. According to the complainant, it was an obligation on the part O.P.No.1-Poona Hospital to recognize Mahendra as a patient at risk since he was immobile and unconscious. Chest physiotherapy was must since Mahendra had undergone Tracheostomy. The physician-in-charge should have encouraged family participation in giving exercises and body repositioning and should have asked for male orderly to attend Mahendra at any cost. The physician-in-charge should have informed them about formation of bedsores and muscle contractures developing into rigidity. The neurosurgeon should have recommended MRI and should have acquainted complainant with his impression of brain stem injury. The neurosurgeon should have given him discharge summary when Mahendra was discharged so as to enable him to consult eminent Neurosurgeon about brain stem injury. The Neurosurgeon should have come with him to Port Trust Hospital/O.P.No.2 or should have sent his assistant to estimate the progress. Nursing staff never made attempts in repositioning of Mahendra body while lying in the bed. He was never made to sleep on right or left side or in prone position. The physiotherapist came with interns only once or twice and tried traction only once. He never attempted movements of fixed joints. The nurses never gave him passive range of movements. Mahendra did not receive physiotherapy for his upper limbs. Only once during his 37 days stay in O.P.No.1-Poona Hospital traction to his lower limbs was applied. But, it was immediately removed when Mahendra showed signs of great pains. They were never shown his bedsores or muscle contractures even on the day of discharge. Whenever bedcovers were changed or cleaning of the body was carried out, they were never allowed to remain inside in the I.C.U. Patient having diseases like Asthma, Gangrene and Rabies were in the vicinity of Mahendra in I.C.U. The nurses were not dutiful during night time.

(3.) Complainant alleged that though his son was immobile and unconscious and lying in supine position day and night, his body positioning was not done regularly and he developed four bone deep bedsores. He also developed complete rigidity of joints and multiple contractures in all his four limbs. If proper care should have been taken, this complication would not have developed alarming proportions. Treat and prevention was the duty of hospital staff. Hospital never acquainted them with these complications. They came to know all these bedsores and contractures in the Port Trust Hospital on the day of his admission in Port Trust Hospital, Mumbai on 03/04/1997. Mahendras physical condition, immobility and incontinence were prone to the formation of bedsores and muscle contractures. Preventive measures should have been taken by the physician attending him. Physician should have given strict instructions to the nursing staff and physiotherapist about bedsores formation and muscle contractures and family members should have been acquainted with these complications. Due to bedsores and muscle contractures, future rehabilitation of Mahendra was not possible. He could not be given actual physiotherapy due to bone-deep bedsores. It resulted in severe contractures and Mahendras rehabilitation programme totally failed because of deficient services on the part of O.P.No.1-Poona Hospital. Mahendrea bed was in the vicinity of other patients suffering from Asthma, Rabies and Gangrene. Viral infection must have aggravated the severity of ulcers. He asserted that most effective method of preventing bedsores is regular turning of the patient body at 2 hourly intervals. Formation of bedsores and muscle contractures is regarded as the emblem of bad nursing. Their onset could have been delayed if patient received proper nursing and attention, but Mahendra never received regular turning day and night. Family participation was never suggested on this count. In not taking proper care in two hourly changing body position by the hospital staff was per se negligence on the part of Poona Hospital. Skin flaps was done on all the bedsores in Pune Institute of Neurology on 15/05/1997. Three times in a day daily flaps were cleaned and dressed till December 1997 i.e. for more than 7 months. The healed sinuses look like craters making Mahendras buttocks look very ugly which clearly shows extensive damage done due to negligence of Poona Hospital. Deficiency in service lies in the fact that Poona Hospital did not understand the problem faced by Mahendra which led to complications. Repositioning of the body was not done to prevent bedsores formation. Mahendra did not receive exercises of joints at any point of time while he was staying in I.C.U. He was always lying on his back. Only on 37th day of his stay he was given prolonged stretch to his legs by applying load, but it was immediately discontinued since Mahendra shown signs of extreme pain. The physiotherapist was negligent in not supervising and treating both fixed and flaccid joints. Mahendras final diagnosis confirmed that he was having mild post traumatic diffuse cerebral oedema and fractured right lateral wall of right orbit. Follow up of C.T. Scan study on 28/02/1997 showed that there was some patchy cerebral oedema with better visualized basal cistern and ventricular system. The small area of cerebral contusion was seen deep in the left temporal region. This was the final diagnosis when Mahendra was discharged from Poona Hospital on 03/04/1997. According to the complainant, Mahendras legs had became weak as muscles were cut to release contractures. Because of deviated pelvic girdle, his hip joints were distorted. Therefore, he cannot maintain erect posture. Cause of deformity originated and culminated in Poona Hospital itself. Contractures in both hands could not be released due to rigid muscles. Physiotherapy and massaging has helped him in movement of hands.