HomeLegal NewsRelief to Orthopedician: Conservative management of fracture does not amount to negligence

Relief to Orthopedician: Conservative management of fracture does not amount to negligence

New Delhi: The District Consumer Dispute Redressal Commission of North East Delhi have held that the conservative treatment of fracture and not opting for operative management of the fracture does not amount to negligence. The District Consumer forum dismissed a complaint of medical negligence in treating the fracture in right knee of the complainant against Indira Gandhi ESIS hospital along with two orthopedician and an MBBS doctor from ESI dispensary.

According to the complainant who was insured under the Employee State Insurance Corporation (ESIC), suffered a knee fracture due to an accident in Noida. The Complainant got himself admitted in the Lal Bahadur Shastri Hospital where after proper diagnosis, it was found that the right knee of the Complainant had fractured and broken. Next day the complainant was discharged from Lal Bahadur Shastri Hospital after initial treatment but was not satisfied by the treatment and hence sought advice from Indira Gandhi ESIS hospital where the senior orthopedician and the HOD, Orthopaedic department advised him conservative treatment of fracture. The consulting orthopedicians advised the complainant to get the injured knee plastered instead of undergoing bone surgery. As advised by the consulting orthopedicians, complainant got plastered on his injured knee whereby he was advised to take complete bed rest for three months. After 3 months the complainant got the fitness certificate from the consulting orthopedicians and resumed his work. After the lapse of few days the complainant felt excruciating pain in the injured knee at the exact point where he had suffered fracture/bone knee. The complainant opted for second advice and went to the Shanti Mukand Hospital, Karkardooma, Delhi for emergency check-up and an X-ray was done by Shanti Mukand Hospital. The doctors of Shanti Mukand Hospital observed that injured/fractured knee had not been joined and advised the complainant to undergo bone grafting surgery for his injured/fractured knee which was done after which he recovered completely. The complainant alleged that the consulting orthopedicians of Indira Gandhi ESIS hospital were negligent since they opted for conservative treatment of fracture rather than operative management of the fracture.

The hospital and the orthopedicians in their defence said that they have done the X-rays and scan of the knee of the complainant and on the basis of investigations the complainant was diagnosed as Medial tibial condyle fracture Right side (tibial pleateu) with minimum displacement. It is stated that there was option of operative management versus conservative as the depression is fracture was less than 5mm. It is stated that as operative management has its inherent complications like infection and wound gaping at the site as the plate was fixed just under the skin. So, it was decided to go for conservative management. After 3 months before giving fitness the orthopedicians have opted for a final X-ray and did not find any displacement of fracture neither did the complainant complained about any pain in the knee.

The consumer forum opted for medical expert opinion and constituted the board consisting of Dr. V.K Goyal and Professor, Dr. Manish Chadha of GTB Hospital and they gave the opinion “ that complainant had minimally displaced medial condyle fracture (Rt) tibia, which can be treated conservatively in plaster cast or operated, and both the treatment modalities are accepted methods of treatment If the patient is treated conservatively in plaster cast, and later on if it is found that fracture gets displaced/malunites and patient becomes symptomatic, then a corrective surgery is require.” As the expert opinion clearly stated that the orthopedicians of Indira Gandhi ESIS hospital had offered treatment as per the standard medical practice the consumer forum held the Indira Gandhi ESIS hospital along with two orthopedician and an MBBS doctor from ESI dispensary as not negligent as there was no deficiency in the service provided by them to the complainant.

Legal PrescriptionThe treatment offered by the doctor should be as per the accepted standard medical practice and should be supported by medical literatureIf the doctor has more than one line of treatment that can be offered to the patient for treating its disease/issues, the doctor should explain the benefits and risks associated with each and every line of treatment. The doctor should suggest and advice the best line of treatment to the patientThe consent for the treatment opted for the treatment of the patient should clearly state that the patient has been explained different line of treatment, benefits and risks associated with the line of treatmentIn medical negligence the opinion of the medical expert is of paramount importance and hence the doctor should take the help of medicolegal expert while replying to the queries raised by the medical expert team