Doctors cannot be always blamed, as some complications (like AFE in the present case) are unexpected, unavoidavle and unpreventable. : Adv. ROHiT Erande. ©
Doctors cannot be always blamed, as some complications (like AFE in the present case) are unexpected, unavoidavle and unpreventable. :
Adv. ROHiT Erande. ©
The judgment beings with following observation :
" The blame of tragic misfortune for unexpected, unavoidable,
unpredictable, unpreventable Amniotic Fluid Embolism ( AFE), most of the
times the obstetrician is a scapegoat. Unfortunately in some cases,
despite the doctor’s best intentions, patients suffer injury or die, and the
clinicians involved often become the secondary victims."
Case
Details :
Dr.
Manisha Agarwal, UP & anr V/s. Kapil Bajaj & anr.
First
Appeal No.1107/2018, decided on 18th June, 2020.
Before
: HON'BLE MR. JUSTICE R.K. AGRAWAL,PRESIDENT HON'BLE
DR. S.M. KANTIKAR,MEMBER
The Judgment Link :
1. The Wife of the Complainant
-Opponent No.1, Mrs. Parul Bajaj was pregnant and was taking treatment from the
Appellant herein. On 04/11/2012 due to labor pains she was admitted in
the opponent's Hospital, where she was advised that everything will be as per
protocol. Due to pains the patient was given some injection and thereafter such
situation was created that compelled to the patient's attendant to give consent
for LSCS.
2. The Anesthetist was also not
present when the unfortunate incident happened. It was alleged that LSCS was performed
carelessly. 4-5 hours were wasted and thereafter the Opponent No.1 suggested to
take the patient to some super specialty hospital and the patient went in coma.
3. Under the circumstances the Complainant
- Husband filed a case before UP state commission for claiming Rs.99,00,000/-
as compensation and also a complaint with UP Medical Council.
Defense of The Doctors.
1. The Doctors denied all the
allegations. The Doctor was a well qualified Doctor with 17 years of
Experience. It was alleged that the labour pains were increasing, but
there was no visible progress in cervical dilatation.
2. As the fetal distress was
noticed, the Doctor explained the patient and her husband about the risk to the
baby and suggested LSCS delivery. However from the patient side, there was no
response or consent for LSCS and therefore the Doctor had not choice but to ask
the patient to make a choice between LSCS or to go to any other Hospital. Only
then the informed consent was given from the patient’s side.
3. The spinal anesthesia was
given by an anesthetist Dr. Neelam. The LSCS was performed as per SOP, the OT
was fully equipped and a healthy baby girl was delivered at about 1.20 pm. But
suddenly suddenly the patient developed cardio respiratory arrest.
Amniotic Fluid Embolism (AFE) was suspected and immediately resuscitation
was started. The patient was intubated and started positive pressure
respiration. But considering the emergent situation, the Doctors advised
the patient to be shifted immediately to super hospital and was shifted in
ambulance with Opponent No.1 Doctor accompanying to the nearest tertiary
care centre at Yashoda Hospital with the positive pressure respiration. The
patient was put on Ventilator in the said Hospital.
4. I was contended that there was no
negligence while performing LSCS and an occurrence of AFE was not due to
negligence of doctor.
The report in nutshell recorded as
under :
".....After resuscitation
cardiac activity returned but respiration did not recover. She kept the
possibility of Amniotic Fluid Embolism for coma.
The Ethical Committee is the opinion
that Dr. Manisha Agarwal should be restricted to operate in such facilities
which seems not upto the mark. Chief Medical Officer, Ghaziabad should be
informed that Dr. Manisha Agarwal will not operate in this hospital unless the
facilities are improved.
The Moot question before national commission was .
Whether there was any negligence and any deficiency in
service while performing LSCS by the Opponent No.1 Doctor.
Held :
1. The National Commission after perusing
the records, arguments and the medical literature came to the rescue of
Doctors.
2. It was relied upon the Medical Literature,
which showed that Amniotic fluid Embolism is a rare but often fatal
complication of pregnancy and its onset can neither be predicted nor prevented.
AFE is an infrequent, unpredictable. AFE is a syndrome typically occurs during
labor, soon after vaginal or caesarean delivery, or during second-trimester
dilation and evacuation procedures. It is virtually impossible to predict which
patients are at risk for AFE. The Cardiac arrest is a devastating event.
Despite improving resuscitation practices, mortality is high with many
survivors being left with severe neurological impairment. However, some do make
a good recovery and return home to a meaningful quality of life.
3. The Commission further observed
and held that the UP Ethical Committee report also has not held Dr.
Manisha Agrawal for procedural lapses or negligence while performing LSCS and
it further held that AFE is an unpredictable complication, and it was managed
by the OP-1 efficiently and made timely reference to the higher center for
further management. Thus, any failure in duty of care from the treating doctor
is not visible.
4. The Commission also relied upon
various judgments of Hon. Apex Court and allowing the Appeal of Doctor observed
that In order to succeed the claim in medical negligence case three
requirements need to be met. One the accidental nature of the misconduct on the
part doctor, second the existence of proven damage and third its direct
relationship. The doctor shall put in place all necessary measures as to the
current scientific knowledge. We note the Doctor performed her duty with
reasonable standards and as per accepted practice. The patient was
appropriately referred to the higher centre.
This is indeed a very good decision. No doubt whatever happened with the patient was really unfortunate for herself and for her family, for her baby. But the fact remains that Medicine is an incomplete science. Almost all the Doctors would agree that human body is yet most mysterious machine on the earth and no one could predict what can happen in any procedure.
Long back, it has been aptly observed by Hon. Apex Court in the case of Achutrao Haribhau Khodwa a& ors. V/s. State of Maharashtra and others (1996) 2 SCC 634 that, ".... but as long as a doctor acts in a manner which is acceptable to the medical profession, and the Court finds that he has attended on the patient with due care skill and diligence and if the patient still does not survive or suffers a permanent ailment, it would be difficult to hold the doctor to be guilty of negligence.
All the best and take Care..
Thanks and Regards,
Adv. ROHiT ERANDE. ©
Pune.
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