“It should be borne in mind that ‘No cure is not negligence’ despite reasonable treatment if there is no improvement.” 

Facts:

• This matter pertains to alleged medical negligence of the Opposite Party causing Radial Nerve injury. OP- doctor while administering the injection (Diclofenac) should have chosen patient’s muscular portion like buttocks but the OP chose the left arm and negligently administered injection of Diclofenac without reasonable skill and care. Thereafter, patient suffered “Higher Radial Nerve Palsy” and disability.

• Patient was under her treatment from May 2001 to September 2001. During that once he gave injection Diclofenac and she got relief. Thereafter, in the month of September 2001 he referred the patient to Kasturba Hospital (Mahatma Gandhi Institute of Medical Sciences), Sevagram (for short MGIMS). OP prescribed only pain killer medicines. The counsel further submitted that Dr.Vinod Bele (OP) is a qualified Anesthetist. Moreover, the Anesthetist are more trained and experienced in various techniques of administration of injections (IM/IV etc). 

• On perusal of medical record and the literature from the standard medical books, the undisputed facts are that complainant was suffering from arthritis (pain in wrist and knee joints) since 2-3 months she was under treatment of OP- Dr. Bele till September 2001. On record there are only two prescriptions of OP dated 8.10.2001 and 16.10.2001 revealed medicines Piroxican (the pain killer) and Nicort (steroid). Nothing is on record to prove that the OP administered injection on 8.10.2011. 

• It is further to note that, the patient did not approach OP immediately for the alleged suffering of “Radial Nerve Palsy” after taking the alleged injection on 08/10/2001. As per the prescription patient approached OP lastly on 16.10.2001 and OP prescribed medicines for acute arthritis. The record also revealed that patient approached MGÍMS on 26.12.2001 i.e. after the lapse of 70 days of the alleged injection. Therefore, it is difficult to ascertain about any injury suffered by the patient or any other treatment taken between 16.10.2001 to 26.12.2001. 

• It revealed that an iatrogenic injection-related peripheral nerve injury is not an uncommon problem. An early diagnosis, timely reference to a specialized peripheral nerve center, and an early intervention are few important factors that can provide an encouraging outcome. In majority of the cases, the problem can be avoided by having a thorough anatomical knowledge. The radial nerve is the most common nerve in the upper extremity to be affected by trauma. The most frequent etiologic agent is the fracture of the middle third of the humerus. Some other reasons for the palsy of this nerve include entanglement of the nerve within the fibrotic bands of the external head of triceps muscle, iatrogenic trauma during surgical procedures, ganglion in the elbow area and severe muscular effort; etc .The trauma might be in the form of pulling, compression and in rare cases, amputation. These traumas usually occur distal to the branches innervating the triceps muscle. 

• It is pertinent to note the report and the affidavits filed by Dr. C.M. Badole, Professor of Orthopedics and Dr. Amit Chaturvedi, Lecturer in Orthopedics at MGIMS states that the said injury was curable and the chance of recovery was at par with any other injury of the body. The patient took treatment in the MGIMS for four months and she was having positive evidence of recovery but thereafter she did not come in the hospital for follow-up examination. Thus due to the long standing Arthritis she suffered disability. 

• The complainant failed to produce any cogent evidence or any expert opinion that the OP treated the patient negligently and caused post injection radial nerve palsy. On the contrary as per medical literature the nerves may be damaged due to various reasons like laceration, contusion, traction, compression, friction, burns or ischemia. 

• Based on the medical record, the literature in my view the OP acted with the reasonable skill and care while treating the arthritis patient and the referral was also proper to MGIMS, Sevagram. The patient took treatment at MGIMS Sevagram however she did not improve completely. The disability was due to long standing arthritis but not due to nerve palsy as alleged. It should be borne in mind that ‘No cure is not negligence’ despite reasonable treatment if there is no improvement.