1. The instant Appeal has been filed by Dr. Rajesh L. Tate - and the Tate Hospital i.e.Appellants -Original Opponents, against the Order dated 04.02.2015 passed by the Maharashtra State Consumer Disputes Redressal Commission (hereinafter referred to as the ‘State Commission’), wherein the Appellants were held liable for medical negligence.
2. One Smt. Mayuri S. Brahmabhatt ( the deceased ‘Patient’) during her 2nd pregnancy was visiting the Opponents for regular check-up. On 19.09.1995, Dr. Tate, examined her and informed the couple that the baby was full term, matured and the delivery could occur at any time. He further advised to bring the patient immediately on noticing pain, signs of bleeding or fluid.
3. At home, on 20.09.1995 at about 5.30 am, the patient started bleeding and immediately she was admitted to the Tate Hospital at 6.30 am. At 6.45 am she was examined by Dr. Tate and decided to perform Lower segment Caesarean Section (LSCS). The consent was obtained from her husband Mr. Sushrut Brahmabhatt (i.e. the ‘Complainant No. 1’). The Anaesthetist Dr. (Mrs.) Kelkar, who has also been arrayed as Opposite Party No. 3, arrived at 8.00 am and the patient was taken to the operation theatre for LSCS under spinal Anaesthesia. It was alleged that at 8.45 am, the Dr. asked the patient’s husband to get a bottle of Haemaccel which was immediately purchased from local Pharmacist along with other medicines. At 9.30 am, the patient delivered a female baby.
4. It was alleged that said Dr. Tate told his assistant to call urgently another Gynaecologist and also told the relatives of patient to arrange ‘A-Negative’ blood. A note on a piece of paper was given for Amit Biological Blood Bank, Vasai for supply of blood. It was further alleged that the person who went to the Blood Bank returned because the blood samples were contaminated, therefore pure sample were redrawn and given with a proper requisition slip to the Blood Bank and thereafter at about 10.30 am, 4 bottles of blood were arranged. In the meantime, due to anxiety, the co-brother of the Complainant, Dr. Ram Barot, contacted one Gynaecologist, Dr. Asha Sharik at Mallad, who performed 1st LSCS of the patient. She telephonically gave instructions to Dr. Tate to shift the patient to Bhagwati Hospital at Borivali where she could perform emergency hysterectomy to save the life of patient.
5. The Complainant submitted that Dr. Ram Barot arranged 18 bottles of A Negative blood at Bhagwati Hospital and requested few doctors to remain present there. It was further alleged that the relatives requested Dr. Tate to shift the patient to Bhagwati Hospital, however because of heated arguments between Dr. Tate and the relatives, the request was refused. It was further alleged that at 3 pm, when the things were beyond control of Dr. Tate and he realised the patient could not be saved, then decided to shift the patient to Bhagwati Hospital.
6. While shifting Dr. Tate and Dr. Kelkar accompanied the patient in the ambulance which reached at Bhagwati Hospital at 4.30pm, but the patient was declared dead before admission. The Post-Mortem (PM) was performed and the cause of death was stated as “haemorrhagic shock following surgery”.
Being aggrieved by the alleged deficiency and negligence during the treatment (LSCS) causing death of the patient, the husband of the patient alongwith two minor children Ms. Krupali and Ms. Hetal filed a Consumer Complaint before the State Commission.
Defence of Opponents :
1. The Opposite Parties filed their reply and denied all the allegations of the negligence and deficiency during LSCS. Dr. Tate admitted that it was 2nd LSCS and a female child delivered at 9.30am and that because of patient previous delivery and her rare blood group (A negative); he specifically advised the couple to go for delivery, where Blood Bank facility is available; however the couple expressed their inconvenience go to other place and decided for delivery at his Hospital.
2. The patient’s husband assured to arrange required blood but he failed to arrange blood in time, therefore, Drs arranged the blood from the Amit Blood Bank. After LSCS, the patient suffered profuse bleeding, therefore another Gynaecologist was called for help and make every possible efforts to treat the complications. Lastly, the decision was taken to shift the patient to Bhagwati Hospital at Borivali(W) and the patient was duly accompanied by Dr. Tate and Dr. Kelkar in the ambulance, but unfortunately the patient died on reaching the Hospital. Therefore, there was neither negligence nor deficiency on the part of the Opposite Parties and the Complaint being frivolous, prayed for dismissal of the Complaint.
Upon hearing the parties the State Commission partly allowed the Complaint and directed the Parties to pay Rs. 16 lakh as compensation and Rs. 15,000/- towards the cost of the litigation to the Complainant. Hence the Appeal.
Held :
1. The National Commission framed two issues i.e. whether the Opposite Party No. 2 Dr. Tate failed in his duty of care ? and secondly, whether it was reasonable care during treatment of the patient ?
2. The Complainant in his support filed an opinion and affidavit of Dr. (Mrs.) Jennifer Sheth, a qualified Obstetrician and Gynaecologist, having 27 years of experience. The opinion was sought by complainant through the Association for Consumers Action on Safety and Health (ACASH). The commission observed that the opinion mentions that as the patient was ‘A’ Rh- Negative and had 1st LSCS delivery; therefore in 2nd delivery there were chances of unexpected uncontrolled haemorrhage.
3. The treating doctor should keep sufficient “A negative” blood ready or make necessary arrangement to handle such complication. The expert has further opined that the “emergency hysterectomy” or “vessel ligation” was necessary. The operative notes revealed that- there was difficulty in separating bladder and 1 inch lateral tear on both the sides of the uterus. It was one of the causes of bleeding. It is apparent from the record that the bleeding was not controlled for 1 ½ hour after the birth of the child.
4. As per medical text under such circumstances, the “emergency hysterectomy” or “internal Iliac Ligation” was to be performed and then the patient could be shifted to the higher centre. It was further observed that , if we consider because of atonic uterus and adhesions caused primary haemorrhage which led to DIC; the patient could be saved if the blood and blood components were given in time and later on the patient to be shifted the higher centre.
5. Because cross-matched blood is not always available, maternity units should have immediate access (within 5 min) to O-negative blood. Consequently, in our view all maternity units should have their own reserve of blood products if there is no blood bank on-site.
6. The commission refused to agree with the contention that the Donors were readily available because, there is nothing on record to prove that the Opposite Party No. 2 took sufficient steps to keep A Negative blood ready. Beforehand the patient’s blood was not sent to the blood bank for Grouping & Cross matching.
7. It was further held that it is evident from the clinical notes that Dr. Tate failed to control / arrest the bleeding till 12.30 PM & he failed to take immediate surgical intervention or failed to refer the patient to any higher centre and the notes show, the patient developed Atonic PPH at 9.30 am, but crucial period of 5 to 5 ½ hours was lost before transferring the patient to Bhagwati Hospital.
8. It was observed that the expert opinion of Dr. Jennifer Sheth can't be faulted. The treating doctor (Opposite Party No. 2) failed to exercise reasonable skill and care. In our considered view, the delay in referral was fatal; it was Negligence per se.
9. The Commission also relied upon the Testimony of the Opponent's expert Witness Dr. Prakash Pawar, who in his Cross examination admitted that in case of uncontrolled bleeding, he would have gone for hysterectomy that internal iliac ligation.
10. The commission also refused to accept the submission of opposite parties that the cause death was AFE (Amniotic fluid embolism). As firstly, such defence was raised at the first time before this Commission and the Physician Dr. Deshpande who was present at the relevant time, could have easily diagnosed AFE from the ECG monitor.
10. The Commission also relied upon the Medical Literature on the topic of PPH, its causes and Treatment. It was observed that Postpartum haemorrhage (PPH) is the leading cause of maternal death. In developing countries, approximately 8% of maternal death is caused by PPH. The diagnosis of PPH begins with recognition of excessive bleeding and targeted examination to determine its cause.
11. The commission lastly observed that even if, we assume that the efforts were made by Dr.Tate to procure ‘A Negative’ blood, the fact still remains that but for he was knowing that it was rare blood group and chance of unexpected bleeding during 2nd LSCS, it was duty to keep standby blood bags and/or A or O Negative live blood donors before proceeding LSCS and it was lack of adequate care after the LSCS which led the patient into hemorrhagic shock. Under these circumstances, and in the absence of any valid explanation by the Opposite Parties which would satisfy us that there was no negligence on their part, we have no hesitation in holding that Patient - Mayuri died due to negligence of Opposite Party No 2. It was an act of Omission from the Opposite Party No. 2 wherein it fell below that of the standards of a reasonably competent practitioner in his field.
In my opinion of course maternity center should have arranged necessary blood group prior to surgery otherwise would not have taken this case. Only in emergency case they could have taken chance to operate but same time would have referred this case to higher center if blood group was not available. I know every doctor tries his best to save any life but you never knows. As far as negligence is concerned we have seen in Corona pandemic oxygen was not available in most of the hospital and people lost their life. Did any court passed any judgement? I believe only doctors are vulnerable. There should be trust between patient and doctor's relation to avoid these kind of situation.
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