A three-member committee, which probed the case of an 18-month-old boy whose parents alleged that medical negligence led to the amputation of his right arm, has observed that arterial thrombosis and vasculitis was probably due to pseudomonas, a bacterial infection, that resulted in acute ischaemia of the right upper limb leading to the amputation becoming necessary.
Official sources said the committee’s inquiry report was submitted to the State government.
Doctors of Rajiv Gandhi Government General Hospital (RGGGH), where the child was treated had earlier stated that arterial thrombosis had led to limb ischaemia. Now, the committee, which comprised N. Sritharan, director of the Institute of Vascular Surgery, P.S. Shanthi, Director (in-charge), Institute of General Surgery of RGGGH and C. Ravichandran, head of department, Paediatric Haematology, Institute of Child Health and Hospital for Children, has pointed out in its report that the arterial thrombosis could probably be due to pseudomonas, an organism known to cause vasculitis and thrombosis of arteries. The Cerebrospinal Fluid (CSF) culture (a sample of which was taken) grew pseudomonas, while a biochemical analysis revealed low CSF sugar (11 mg/dL) and high protein (97 mg/dL), suggestive of a brain infection, the report said.
The team’s observations ruled out delays in treatment. It said the child, Mohammed Makir, was admitted and surgery was performed without delay. The IV cannula was not inserted into the artery as per the claim of the parents and the treating team, and there was no extravasation of the drug at the IV site (no blebs/swelling).
Following complaints of pain and colour change, the cannula was removed by the duty staff nurse and the patient was attended to by the duty doctor. The diagnosis of thrombophlebitis was made and treated accordingly, and once there was worsening of the discolouration and loss of movement on the right upper limb, a diagnosis of acute ischaemia was made.
The child was born preterm with low birth weight. He was found to have tetra ventricular hydrocephalus with Atrial Septal Defect at five months of age. He had a developmental delay and lower limbs spasticity. In May 2022, he underwent a ventriculoperitoneal (VP) shunt procedure for hydrocephalus. He then had a cardiac arrest and was admitted to the paediatric intensive care unit for a month and then discharged. He was on regular follow-ups at the Department of Neurosurgery. On June 25, the child was brought to the outpatient department for protrusion of the shunt tube through the anal canal.
The child was extremely low weight (severe acute malnutrition) and was admitted at 3.58 p.m. Opinion on fitness for surgery was obtained from the cardiologist and anaesthetist, and fitness was given as ‘high risk’. The child underwent a VP shunt replacement surgery on the same night after obtaining informed consent from the parents. A CSF sample shunt tube was sent to the microbiology and biochemistry departments for a culture and analysis on June 26. The child was started on oral feeds, IV antibiotics and anti convulsants at periodic intervals.
On June 29, the mother noticed that the child was crying incessantly and had redness in the right hand after administration of IV drugs. She informed the staff nurse and the IV cannula was removed. She again complained in the night to the duty staff nurse, who in turn informed the duty postgraduate (PG) medical students and the child was seen by the PG. On June 30, a team of professors and an assistant professor examined the child and a diagnosis of thrombophlebitis was made and treated.
Following increasing discolouration of the right hand and loss of movement on July 1, the vascular surgeon and radiologist were asked for their opinion. A diagnosis of acute ischaemia of the right upper limb was made following a colour Doppler. As the ischaemia was advanced and the right upper limb was non-salvageable, the child was shifted to ICH for amputation.
The committee conducted an inquiry with parents of the child and all doctors and staff nurses involved in his treatment.
