EXPECT 20 LAC COMPENSATION FOR EXTRAVASATION OF IV FLUIDS CAUSING CELLULITIS AND GANGRENE LEADING TO AMPUTATION;
It is frequent in wards of hospitals to see patients developing extravasation of drugs and fluids into sub cutaneous tissue leading to thrombo-phlebitis , swelling , discolouration, cellulitis, compartment syndrome, gangrene rarely leading to amputation. Honourable Supreme Court in August 2014 in a case involving Manipal Hospital and now Bombay High Court on 21st December 2015 in a case involving a Municipal Corporation Hospital have established a benchmark compensation of approximately 20 lacs for such cases. This is an important development which has escaped attention of medical community to date. The patient in question in the case decided by Bombay High Court was suffering from cerebral malaria and meningitis , was restless and uncooperative. Negligence of hospital staff in failure to prevent extravasation has been termed Resp ipsa Liquitor by Bombay High Court.
Extravasation of fluids and IV drugs is frequently unavoidable. 99 % fluid may go into the vein with extravasation of remaining 1 % due to leakage through the needle vein puncture site specially after repeated injections causing thrombosis in vein distal to the cannulation site. The entry site of needle into the vein gradually expands over the course of time specially if there is movement of the limb. This causes some space to develop around the needle and the vein facilitating leakage of small amounts of fluid and drugs into the subcutaneous tissue. This may not be negligence of healthcare providers and which of these patients is going to develop gangrene is not in the hands of doctor. The cascade of events set forth by irritation of extravasated drugs and fluids may lead to compartment syndrome and gangrene in some cases. Gangrene because of inadvertent injection into artery instead of a vein would be condemned as negligence by medical professionals outright. But extravasation from a veinous cannulation leading events which result in amputation is something which needs to be looked into and discussed.
However to discuss and debate we first need to identify and recognize a problem. In our country where an average doctor does not take professional indemnity insurance of more than 10 lacs these compensations of 20 lacs plus for loss of 2 fingers makes me worried as to what compensations would have been if the disability was higher.
