The patient visited a doctor at the hospital to take treatment for boil on her nose. The doctor performed X-ray and diagnosed keloid on the right dorsum of her nose.
The doctor administered an injection which caused severe complications. Within fifteen minutes, the patient had bouts of vomiting and became unconscious. After regaining consciousness, to her shock and disbelief, the patient lost vision in the left eye and had problems with vision in the right eye as well.
She was referred to another hospital where her condition was diagnosed as Central Retinal Artery Occlusion (CRAO) in the left eye. The patient had permanently lost vision in the left eye!
Evidently, her family was quite devastated. They sued the doctor and made a pointed allegation. The doctor did not refer to injection manufacturer’s literature which specifically advised against administering it around / in the eye and certain parts of nose due to risk of blindness and possible damage to the eye.
The doctor refuted this allegation and presented his side of the story. At the outset, he stated that which parts of nose where the injection was not to be administered was not mentioned in the literature. In fact, the literature mentioned ‘administration of injection intraocularly or into the nasal turbinates is not recommended’. It shows that it can be safely given in the keloid intralesionally. The specified areas – intraocularly or the nasal turbinates were not injected, further stated the doctor.
Concluding his arguments, the doctor also cited medical literature which indicated that although rare, loss of vision was known complication of administering the injection.
After carefully going through medical records and medical literature, the Commission rejected doctor’s defence, and stated the following:
“Although, it is mentioned in medical record that the test dose 0.1 ml was given at 12.30 PM and showed no reaction, careful observation of medical record reveals that there are cuttings at the dose and word after. The test dose should have been mentioned in the medical record at the first instance and, thereafter, the actual dose administered should have been mentioned. The cutting clearly shows tampering in medical record. Even otherwise, the doctor has failed to explain how and why this has happened, when the injection caused reaction to such a severe extent in just twelve minutes which completely damaged vision of left eye. There is some damage to patient’s right eye too”.
“Even the complete details of medical records are missing. The consent form is a stereotype document. There is no mention of treatment and it is also not signed by the doctor. Even no date is put on it. Risks and complications of the injection have also not been disclosed in it. It cannot be termed as a valid consent. Thus, it is proved that neither any proper informed consent was taken, nor the risks and complications were ever informed before administering the injection”.
“Furthermore, medical records suggests that there is no recorded side effect of the medicine. Nowhere, it is mentioned that it cannot be given around the nose. However, as per the medical literature, the same cannot be given near the eyes, specifically in the nose nasal turbinates. It is also clearly noted that injecting intraocularly is not recommended. That is altogether different from injecting into keloid”.
The doctor was held negligent on several counts. Not adhering to treatment protocol, overwriting in medical records, not taking proper consent and not informing about the injection’s possible complications.
Source: Order pronounced by Punjab State Consumer Disputes Redressal Commission on 27th January, 2021