1. The Complainant and her husband filed the complaint against the Hospital and the treating Gynecologists for medical negligence and deficiency in service due to which the Complainants lost their child during delivery and the uterus of the Complainant No. 1 had to be removed. 2. The facts of the Case goes back to year 2013 when the Complainant No. 1 - Smt. Mamta Bhatt, full term primigravida was admitted in Dr. Sushila Tiwari Govt. Hospital at Haldwani (OP No. 1 ) Her mother in law accompanied her. 3. It was alleged that the patient felt labour pains several times, but no heed was paid to her despite many requests made by the patient’s mother-in-law. It was further alleged that for 26 hours after the admission no ultra sound (USG) or other tests were performed. In the early morning at 5.00 a.m. on 08.07.2013, the doctors informed the patient about abnormal foetal heartbeats and caesarean operation was required. It was alleged that the operation was performed by OP Nos. 3 to 5 (Dr. Monika Varshney, Dr. Sakshi Aggarwal and Dr. Garima Sharma), they were junior and inexperienced doctors who performed the operation with the telephonic instructions from OP No. 2 who was not present in the hospital at that time. 4. Unfortunately, the newborn died during the operation and the patient also suffered excessive bleeding due to wrong cut. As the patient began to deteriorate, the patient’s family members contacted Dr. R.C. Purohit (OP No. 6) who immediately intervened and shifted the patient to I.C.U. Due to heavy bleeding, the patient was in shock. The doctors hurriedly without ascertaining the cause of bleeding performed hysterectomy. A total 8-9 unit of blood was administered. The cause of death of the new born was stated to be due to entangled umbilical cord around the neck. The patient was discharged from OP No. 1 Hospital on 20.07.2013. 5. An enquiry committee was set up by OP No. 6 to look into matter of negligence and deficiency in service. The instant case was widely reported and covered in various newspapers. The Complainant No. 1 through RTI got the report of Enquiry Committee and the medical records from the police department. Being aggrieved, the Complainants (1 & 2) filed the Consumer Complaint against the Hospital (OP-1) and the treating doctors for medical negligence and deficiency in service. DEFENCE: 6. The preliminary objection was that the patient was not consumer under the Act, 1986 because the entire treatment was done in a Govt. Medical College and no consideration has been paid by the Complainant. The Complaint was filed beyond limitation of two years of cause of action. Moreover, the Complaint pleadings were not signed by the Complainants before filing in this Commission, but it was signed by the Advocate who has no right and it was illegal. The OPs relied upon the few standard text books namely ‘Clinical Obstetrics’ by Mudallar & Menon, Text Book of Obstetrics by CS Dawan, William’s Obstetrics and Munro’s practical Obstetrics. 7. Dr. Monika Varshney (OP-3) filed her separate written version and submitted that she had no privity of contract and no direct ‘consumer’ relationship within the meaning of Act, 1986. The patient was treated at OP-1 Govt. Hospital free of charge. During operation she found the blood clots in the retroplacentally and three rounds of umbilical cord (UC) around the neck of the baby, therefore, baby could not be saved and emergency hysterectomy operation was performed in presence of Dr. Godawari who was present in the OT at the time of closure. The OP No. 3 submitted that two operations were performed. The first operation was done by the OP No. 3 and the 2nd operation of hysterectomy was done by the Senior Consultant. As per records as well as the reports of the expert committee, the baby had lost its life due to ‘Retroplancental Haematoma’ (blood clot) and due to obstruction of throat because of three rounds of cord. Thus, it was not negligence. 8. The Complainant's blood was Rh -ve and the blood was kept ready after cross match. The progress of labour was continuously monitored and there was no indication for emergency caesarean section. The condition of patient and foetus was normal. The informed written consent was taken in HINDI and it was signed by her mother-in-law Saroj. As labour pain increased and FHS suddenly dropped, therefore, at 4.30 p.m. the decision was taken to proceed with Caesarean Section. The Caesarean operation was completed at 6.15 am but the foetus could not be saved due to three tight loops of cord around the neck and retro-placental haemorrhage. 8. After the operation the patient was shifted to postoperative recovery ward. The patient complained of Palpitation and Ghabrahat at 9.15 am. Immediately senior Obstetric Consultant and Associate Professor on duty Dr. Godawari Joshi ( OP2) examined the patient and diagnosed it as a case of Atonic PPH. Then OP2 informed the HOD Dr. R.C. Purohit (OP-6) and all conservative measures were tried to control PPH. The lifesaving B-negative blood, was transfused as arranged from the hospital. When all conservative Medical and surgical methods failed to control bleeding, therefore emergency Hysterectomy was performed. 10. The learned Counsel further argued that, the written consent was not obtained at the time of admission. The Committee pointed out deficiency in service and negligence at various stages of the treatment by the OPs. Thereafter, Prof. R.C. Purohit (OP-6) in order to safeguard the interest of OP No. 1 to 5, appointed another committee comprising Dr. Smt. Devnanda Chaudhary (Prof Gynaecology and Obstetrician) Dr. Anjali Nautiyal (Gynaecologist ). The said committee gave a non-speaking order absolving the Opposite Parties of any negligence. FINDINGS & DISCUSSION: 1. The hon. commission began the discussion with what is PPH and Postpartum Hysterectomy from the Medical literature on the subject of normal delivery, the PPH and its management. Also perused William’s Obstetrics and Text book by Dr. D.C. Dutta. 2. In the instant case, it is evident from the medical record that the patient was admitted on 07.07.2013 at 1.30 am for normal delivery. Due to increasing pain the senior emergency consultant Dr.Godavari Joshi directed for Caesarean operation on 08.07.2013. It was performed by Dr. Monika Varshney under care of O.P. No.3 in the early morning. At the time of operation blood clots were present retroperitoneally and three rounds of umbilical cord around the baby’s neck. Therefore baby could not be saved. Secondly the patient was transfused B-Neg blood, but due Atonic PPH there was intractable obstetrical haemorrhage thus, to save the life of patient an emergency hysterectomy was performed. In my view, there was no deviation of standard of practice from the treating doctors at OP hospital. 3. The Court relied uon the celebrated judgment of Hon. Apex Court in the case of Jacob Mathew v. State of Punjab (2005) SSC (Crl) 1369 which followed the Bolam’s principles and observed that; "25......At times, the professional is confronted with making a choice between the devil and the deep sea and he has to choose the lesser evil. The medical professional is often called upon to adopt a procedure which involves higher element of risk, but which he honestly believes as providing greater chances of success for the patient rather than a procedure involving lesser risk but higher chances of failure. Which course is more appropriate to follow, would depend on the facts and circumstances of a given case. The usual practice prevalent nowadays is to obtain the consent of the patient or of the person in-charge of the patient if the patient is not be in a position to give consent before adopting a given procedure. So long as it can be found that the procedure which was in fact adopted was one which was acceptable to medical science as on that date, the medical practitioner cannot be held negligent merely because he chose to follow one procedure and not another and the result was a failure." Further in the case of Achutrao Haribhau Khodwa v. State of Maharashtra (1996) 2 SCC 634 wherein the Hon’ble Supreme Court observed as: “The skill of medical practitioners differs from doctor to doctor. The very nature of the profession is such that there may be more than one course of treatment which may be advisable for treating a patient. Courts would indeed be slow in attributing negligence on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution. Medical opinion may differ with regard to the course of action to be taken by a doctor treating a patient, 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.” 4. It was observed that Emergency obstetric hysterectomy (EOH) is generally performed as a lifesaving procedure in cases of rupture uterus, postpartum haemorrhage, morbid adhesions of placenta and uterine sepsis. On one hand, it is used as a last resort to save the lives of mothers and on the other hand women’s reproductive capability is sacrificed. Often it is a difficult decision and requires good clinical judgment. The maternal outcome greatly depends upon the timely decision, the surgical skill and the speed of performing the surgery. 5. Based on the discussion above, it was held that the treating doctors at OP-1 hospital have not failed in their duty of care and they have treated the patient as per the reasonable standard of practice. The death of baby was not due to negligence and to save the life of patient, the decision of emergency hysterectomy was correct. The judgment underlines the important principle that if a Doctor adopts a medically acceptable line of treatment, he/she should not be held for the negative result. In this case it is unfortunate that the baby could not be saved, but the mother's life was saved ! But one point, don't know whether or not argued or came on record that whether USG was done on admission ? Had it been done then immediately LSCS would have been possible ? What say experts ? Adv. Rohit Erande Pune. © |
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