PRESIDENT DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, SAMBALPUR

                             CONSUMER COMPLAINT NO. 81/2021

Present-Dr. Ramakanta Satapathy, President,

  Sri. Sadananda Tripathy, Member,

1. Chandan Mahanand,  

S/o- Late Pruthi Mahanand,

2. Binaya Kumar Mahanand,

S/o- Chandan Mahanand,

3. Parbati Mahanand,

W/O- Late Pruthi Mahanand,

Complainant No.2 being minor represented through his

Father Chandan Mahanand i.e. Complainant No.1

All Complainants are residing at-Ambedkar Nagar, Dhanupali,

Po/PS-Dhanupali, Dist-Sambalpur.                               ...………..Complainant

                                                Versus

1. Dr. Sunil Panda, MD (O&G),

Sruti Maternity & Nursing Home, Budharaja, PO-Budharaja

Ps-Ainthapali, Dist-Sambalpur.

2. Srusti Maternity & Nursing Home,

Represented by Dr. Sunil Panda, Budharaja, PO-Budharaja

Ps-Ainthapali, Dist-Sambalpur.                                   

3. United Insurance Co. Ltd. Represented through its B.M.

Divisional Office, 1^st floor Shivlok complex, Gaity Talkies Road,

Sambalpur.                                                          …………...Opp.Parties

Counsels:-

1. For the Complainant                   :-         Sri. P. K. Mishra & Associates
2. For the O.P. No.1 & 2                  :-         Sri. Jagannath Hota & Associates
3. For the O.P. No.3                                    :-         Sri. B.K. Purohit, Later Withdrawn

Date of Filing:22.03.2023,Date of Hearing :10.07.2023 & 18.07.2023,

Date of Judgement : 04.09.2023

  Presented by Dr. Ramakanta Satapathy, PRESIDENT

1. The case of the Complainants is that Manaswini Mahanand, the deceased is the wife of Complainant No.1 and Complainant No.2 & 3 are their kids. In 2015 when the deceased was conceived consulted Dr. Sunil Panda, Shrusti Nurshing Home but as heard of the foetus was not functioning abortion was made. In January 2020 the Complainant consulted the O.P.No.1 on 08.01.2020, conducted different tests and ascertained that the foetus is of 8 weeks and 4 days. The O.P. No.1 told the Complainant that as the first child is through Caesarean Section, the subsequent delivery is to be made Caesarean Section. Regular check ups on 14.02.2020, 19.03.2020, 17.05.2020,14.06.2020 were done, tests were done and O.P. No.1 prescribed medicines. Till 07.07.2020 no any abnormality observed by the O.P. No.1. During May 2020 ultra-Sonography check up was deferred to 10-15^th of July,2020. On 07.07.2020 the deceased patient complain pain in her lower abdomen and was taken to O.P. No.2 for consultation with O.P. No.1 at 9.00A.M. O.P. No.1 visited indoor at 9.30 A.M. The resident doctor was requested to get her admitted but the resident doctor insisted for urine test and ultrasonography test report first. The resident doctor was a AYUSH practitioner. The complaintant was moving for ultrasonography test giving a seat in the nearby indoor bench. At 9.59 A.M. a phone call came regarding the precarious condition of his wife. The Complainant went to his wife who was lying on the floor of O.P.Np.2 with pain. On repeated request the patient was allotted bed No. G-7 at 10.15AM only but no treatment made till 11.00AM. After repeated request the resident doctor only prescribed pain killer injection “Drotin” but the O.P. No.1 not attended the patient. The O.P. No.1 was engrossed with other out-door patients till 11.45 AM.

At 11.45A.M. the O.P. No.1 checked the patient and told to shift the patient to V.S.S. Medical College and Hospital, Burla. After repeated request also the O.P. No.1 ignored the patient. In the meantime Dr. Raseswari Panigrahi happened to come to O.P. No.2 on the request of the Complainant who checked the patient and told to conduct an operation immediately. On her advice patient was taken to Operation Theatre at 12.45 P.M. and Complainant was told to arrange 5 units of blood. The Complainant by that time arranged two unit blood but Dr. Raseswari Panigrahi informed that there was no further need of blood. The O.P. No.2 officials told to return 1 unit blood as the patient expired before even anesthesia was given. The Complainant became dumb found. For negligence of resident Doctor and O.P. No.1 the patient died on 07.07.2020. From 9.30AM to 12.30PM the O.Ps did not take up the matter with sense of urgency. The resident doctor, not qualified in maternity treatment failed to understand the urgency and O.Ps are negligent in their duty and unfair in trade practice.

2. The O.Ps in their version submitted that this case will not come under “medical negligence.” The O.P. No.1 is that owner of the Shrusti Maternity and Nurshing Home. The O.P. No.1 and his wife Dr. Sarita Hota M.D. (O& G) are its resident doctors. Some other doctor also treat their patient in the Nurshing Home. The O.Ps are insured with United India Insurance Co.Ltd. , Sambalpur vide policy No. 2604002 P116149562 and policy No. 2604002719 P115994782. On 07.07.2020 free treatment was provided to the patient. Dr.Motilal Nayak, Ayush doctor never treated the patient, his work is of an amanuensis and for medical transcription. His work is to look after hospital management. He is not a resident doctor.

The patient was initially treated by Dr. Sarita Hota followed with Dr. Sunil Panda, O.P. No.1, Dr. Raseswari Panigrahi and Dr. Prasanta Mishra, Annaestheticst. All are well experienced doctor and Dr. Panigrahi was a retired professor & HOD of VIMSAR, Burla.

On 07.07.2020 morning the Complainant and his wife complained in passing urine and abdominal discomfort while Dr. Sarita Hota, MD(O & G) on her indoor round. The patient was conscious oriented and condition was stable. There was no regular contractions, having no labour pain, blood pressure(140/80), pulse rate (70) were normal. The LMP was 02.11.2019 and the expected date of delivery was 09.08.2020. It was 33 days before her expected date of delivery. Her pregnancy was in its 35^th week Plus. Longitudinal scar of previous CS was seen. Mild tenderness of lower abdomen was present. The FHR was 144/min. Cervical length was long. Her external OS was closed. There was no abnormal vaginal discharge. At 9.45AM she was admitted and allotted bed No. G-7 at up-stair to which she walked into comfortably and occupied the bed at 10 A.M. At the time of coming three beds were vacant. The patient was suspected to be a case of urinary tract infection or false labour pain for relieving of pain the injection “drotin(Lamp)” was given with advise for investigation for DC, TLC, Hb%, UN-RE & ME (Urine routine and microscopic examination, RBS, Sodium, potassium obstetric USG. Dr. Sarita Hota also consulted the O.P.No.1 telephonically (Who was in OPD looking after treatment of other pregnant patients having difficulty condition). Dr. Nayak noted down the dictations of advice of Dr. Sarita Hota.

At 10.30 A.M. the patient was examined by Dr. Sarita Hota and found that the pain had reduced, pulse was 104, BP (112/60) there was sweating indicative of stress and P/A was having tenderness, foetal heart rate (FHR) was normal i.e. 144. The RBS was 220. On being asked for proceeding to VSG room for examination the patient said she need rest. Dr. Nayak noted down the findings dictated by Dr. Hota.

At 11.45 P.M. When the patient complained for reeling of head on standing position and sitting position, expressed inability to walk to USG room for ultrasonography, pain increased at that time. O.P. No.1 again gave direction to measure BP (90/58mm of Hg), Pulse rate (118/minute), pallor(+), sweating (++) and foetal heart rate was not found. The O.P. No.1 instructed the para-medicals staff not to send the patient to USG room and arrange for bedside USG Examination and to start IV fluid i.e. ringer lactate 1 ltr and accordingly it was administered. After arrival of USG equipment at 11.30 USG performed. The image showed single dead foetus and collection of fluid in the peritoneal cavity, pulse was 122/min, lower volume BP 976/54), patient was rest less, oxygen saturation (84%). A provisional diagnosis of ruptured uterus with haemorrhagic shock was made. The patient’s attendant was informed for urgent need of laparotomy and to arrange 2 units of blood. All stabilisation measures like O₂ inhalation, injection dopamine drip, injection Tranexa given along with IV fluid administration by 11.50AM. It was a case of medical emergency. The O.P. No.1 gave OT call to paramedic staff, instructed to call anaesthetist Dr. Prasanta Mishra and Dr. Raseswari Panigrahi for 2^nd opinion. Option was given to the Complainant for VIMSAR treatment but the complaint opted for treatment under O.P. No.1 Dr. Panigrahi telephoned WGO_s for arrangement of 2units blood.

Around 12 Noon the patient was shifted to OT. She was restless air hunger was present, pulse 140/min, low volume BP(70/50). Foley Catheter given 200ml; clear urine came out it indicates she was not in shock for long time as kidney produced urine. Dr. Prasanta Mishra, Anaesthesist arrived at 12.15PM and examined the patient in O.T. having respiratory distress, the pulse was feeble and fast BP(60/?), pupil semidilated, Reaction to light(R/L) was sluggish 100%oxygenation from Boyel’s machine given, inje. Primacot 200 mg lv, Inj. Dopamine drip given by the anaesthetist. Till 12.30 condition of patient not changed. Patient developed breathing difficulties with gradual endotracheal intubation (ETT) was done and O₂ given from Boyel’s machine with IPPV. Till 12.45 PM condition of patient deteriorated and ultimately cardiacarrest. External cardic message given by the anaesthetist but no improvement in condition of the patient. At 1 PM the patient was declared dead.

The O.P. No.1 suggested for post mortern and informed IIC, Ainthapali PS. The Complainant husband signed a declination note. There is no any deficiency on the part of the O.Ps.

3. Perused the documents filed by the Complainant and O.Ps.

The Complainant filed:

1. Prescription dated 07.07.2020
2. Death Declaration dated 07.07.2020
3. Obstetric Sonography(Level-1 scanning report dated 19.03.2020 with photographs.
4. Prescription dated 08.01.2020.
5. Prescription dated 17.05.2020 & 14.06.2020
6. Thyrocare AC-G, AC-M, TSH report dated 08.02.2020.
7. Pathological Investigation report dated 06.02.2020, 23.12.2019.

Documents filed by the O.Ps:

1. Renewal Registration Application dated 12.02.2018 for Srusti Maternity & Nurshing Home, Sambalpur submitted to C.D.M. O, Sambalpur.
2. Treatment records of the patient Manasnini Mahanand dated 07.07.2020(Admission slip and Bed head ticket)
3. Requisition letter of the S.I. Ainthapali Ps. dated 26.07.2020 to the CDMO, DHH, Sambalpur to constitute Medical Board and report dated 09.03.2021.
4. Intimation letter dated 17.05.2022 of O.Ps to the Divisional Manager United India Insurance Co. Ltd.  along with Policy No. 2604002719P 116149562 and Errors and Omissions Policy No. 2604002719P-11594782.
5. Final form in FIR No. 0363 dated 13.07.2022.

4. After perusal of the documents the following issues are framed:
103606587.  

1. Is there any deficiency in service on the part of the O.Ps causing death of Manaswini Mahananda, wife of the Complainant on 07.07.2020 due to negligence in treatment?
2. What relief the Complainant is entitled to get?

ISSUE NO.1 Is there any deficiency in service on the part of the O.Ps causing death of Manaswini Mahananda, wife of the Complainant on 07.07.2020 due to negligence in treatment?

1. It is the admitted case of both the parties that on 07.07.2020 deceased Manaswini Mahanand accompanying by her husband had been to the O.P. No.1 & 2 with a complaint of passing urine and pain in the abdomen and declared dead on same day at 1.00P.M. The allegation of the complaints is that the doctor who attended the patient on 07.07.2020 prescribed for pathological test and USG and prescribed injection ‘Drotin’ is not a qualified doctor as he was a AYUSH practitioner. Motilal Nayak, the AYUSH doctor acted as per the direction of Sarita Hota and as per her advice the ayush doctor noted down the prescription, it is the submission of the O.Ps. Dr. Motilal Nayak in his deposition stated that

“I have not treated the patient Manaswini Mahanada on 07.07.2020. She i.e. Manaswini Mahananda was first attended by Dr. Sarita Hota, O& G specialist at aboiut 9.30 A.M. and allotted bed No. G-7. Manswini Mahanand was attended for treatment of Dr. Sarita Hota till 11.30 AM in consultation with Dr. Sunil Panda, O& G. I wrote down her findings instructions on medical treatments”

The said fact is corroborated by the evidence of O.P. No.1 & 2. Dr. Motilal Nayak, Ayush doctor’s job is of an amanuensis and for medical transcription in noting down of the advices, instructions, dictations and direction of allopathic doctors including Dr. Panda and Dr. Hota who are the resident doctors of Shrusti Maternity and Nurshing Home, Sambalpur.

From the aforesaid discussion it can be concluded that the Ayush doctor has not treated the patient rather he has acted as per advice and direction of Dr. Panda and Dr. Hota.

2. During the course of argument learned advocate for Complainant Mr. Mishra submitted that ‘Drotin’ injection was prescribed to the patient by Ayush doctor, which he is not legally entitled to prescribe allopathy medicine which amounts to medical negligence. The Ayush doctor is not aware of the side effect of injection “Drotin” and there is every possibility of likelihood of complicacy of vertigo i.e. reeling of head, hypertension (Low blood pressure), fast heart rate and sweating. The bed head ticket filed by O.P. No.1 & 2 shows that after administration of ‘Drotin’ injection the B.P. was 112/60 at 10.30A.M., 90/58 at 11.15 A.M. 76/54 at 11.30A.M., 70/50 at 12 Noon, 50/? At 12.15 P.M. at 11.15A.M. the patient complained reeling of head. It is also recorded at 11.30A.M., 11.15 A.M. that the patient was sweating + and ++respectively. The heart rate/pulse rate of the patient noted as 104 at 10.30A.M., 118 at 11.15A.M. and 122 at 11.30A.M. Mr. Mishra submitted that due to side effect of ‘Drotin’ might have above symptoms developed which amounts to medical negligence.

The patient died due to administration of ‘Drontin’ injection or not the opinion of the experts can be referred. The medical expert committee(report dated 09.03.2021) opined:

“The patient was allotted one bed G-7 at about 10.15 A.M. and patient had been administered 1 amp. Of Drotin prior to that to reduce the pain in abdomen. But when the patient was asked to USG of abdomen and became much serious. Hence one bed side USG was done by Dr. Sunil Kumar Panda at about 11.30 A.M. on 07.07.2020. The USG revealed that there was rupture of Uterus with haemmrrhasic shock with dead foetus. Then he informed the patient’s attendants about the seriousness of the patient”

From the  report of the experts it can be concluded that the death caused is not due to introduction of the Drotin injection rather it is due to rupture of the uterus. The expert committee clearly opined that “The committee also can not held any body responsible for the death of the patient.”

3. It is further alleged by the Complainants that the USG was not conducted at 9.30A.M. or before 10.00A.M. by that time the foetal heart rate sound was 144 and as the pregnancy was 36 weeks, the mother and baby both could have survived. Non conducting of U.S.G. in time resulted death of the foetus and mother amounts to negligence as no proper treatment was provided in time. The patient was stable at 9.30 A.M. The patient was admitted at 9.45A.M. for observation as indoor patient and allotted bed No. G-7 at upstairs and occupied at 10.00A.M.

The O.Ps in their reply submitted that the patient was suspected to be a case of urinary tract infection or false labour pain. At 10.30 A.M. Dr.Sarita Hota found that the pain had reduced, pulse was 104, BP 112/60, sweating indicative of some stress and on P/A she was having tenderness and foetal heart rate was normal i.e. F.H.R. = 144. The patient had no hypoglycaemia. The patient was advised to USG at USG room but she complainant reeling U.S.G. arrangement made near bed.

The Complainants allegations are baseless, rather it is the doctor who takes right decision at right place and time which steps are to be taken. At 11.15 A.M. USG arrangements were made bed side and started IV fluid. At 11.30 A.M. USG was preformed the image showed single dead foetus and collection of fluid in the peritoneal cavity, pulse 122/min, B.P. 76/54, patient was restless, oxygen saturation 84%. Provisional diagnosis of ruptured uterus with haemorrhagic shock made by the O.Ps. For laparotomy attendants were advised to arrange blood. This facts are also reflected in the expert committee opinion.

Expectations of the patient and his/her attendants are more in the hospitals/Nurshing Homes. They expect immediate attention of the doctors. In the present case the patient was attended by the O.Ps managing all their other affairs. Allegation of the Complainants are not acceptable as due care and timely action has been taken by the O.Ps. Certainly intolerantconduct develops with the family members when a patient dies during medical treatment and relatives not accept the death during the stages of treatment. The Complainants can not blame as the doctors provided all possible treatment within their means and capacity. In the instant case Dr. Raseswari Panigrahi and Dr. Prasanta Kumar Mishra also consulted and agreed to perform operation but operation could not be performed before O.T. could be started.

It is a clear case of rupture of uterus with haemorrhagic shock and the O.Ps can not be blamed.

4. The contention of the O.Ps that on 07.07.2020 no any amount has been taken from the Complainants to-wards treatment of the patient. It is admitted by the O.Ps that the deceased was under regular supervision of the deceased and it is not denied that in earlier occasions payment have not been taken from the Complainants. The O.P. No.2 is not a charitable nurshing home and to that effect documents have not been filed. Accordingly, the patient was a consumer of the O.Ps and after her death the Complainants are entitled to lodge complaint.
5. The District Commission is concerned with dealing running complaint. Earlier decided cases against the O.Ps are no way linked with the present cause of action. In Criminal cases behaviours of the parties, antecedents are important to collapse the criminal liability where as in a consumer case the tortious liability is taken into consideration. Accordingly, contention of the Complainants on order in C.C. No. 35/2007 is not acceptable.
6. The O.Ps filed the copy of final report in P.S. Case No. 0363 dated 24.07.2020. The final report is a mistake of fact u/s 304(A)/34 IPC and case has been closed. Criminal case has no connection with civil liability. Both the cases are parallel to each other, hence this commission is not concerned with the result of the criminal case.
7. In Medical negligence, the onus lies on the Complainants to prove that there was negligence on the part of the O.Ps. In the present case the Complainants failed to prove that the O.Ps were negligent which caused the death of patient. The doctors with best of their abilities treated the patient and inevitable can not be prevented.
8. The O.Ps have taken policy No. 2604002719 P 116149562 valid from  17.03.2020 to 16.03.2021 which is a policy professional indemnity for doctors for RS. 50,00,000/- and errors and omissions policy No. 260 400271 P115994782 which covers indemnity and errors & Omissions cover upto Rs. 5.00 alkhs each. The O.P. No.1 & 2 have informed the incident of death of patient to the O.P. No.3 on 17.05.2022 and till date the O.P. No.3 has not settled the claim. The O.P. No.3 appeared in the case but not filed any version.

After careful examination of the documents and pleading of the parties the Complainants failed to prove negligency on the part of O.P. No.1 & 2, the issue is answered in favour of O.P. No.1 & 2.

ISSUE NO.2 What relief the Complainant is entitled to get?

The Complainants have lost their love one while treatment under the O.P. No.1 & 2, they sustained expenditure financially and loss of life also. As the O.P. No.2 Nurshing Home is insured, and due claim has been made but the O.P. No.3 till date not settled the claim which was supposed to be settled in time. As the Nurshing Home is covered under the policy this is a fit case to settle the claim.

Human life is so precious that it can not be calculated in monetary term in case of loss of life. Accordingly, the Complainants are entitled for the claim from O.P. No.3. Hence ordered:

ORDER

The complaint is dismissed against O.P.No.1 & 2 and allowed against O.P. No.3. The O.P. No.3 is directed to pay claim amount of Rs. 30.00 lakhs within one month of this order. In case of non-payment the amount will carry 12% interest P.A. w.e.f. 07.07.2020 till realisation. No other cost.

Order pronounced in the open court on this 4^th day of Sept. 2023

Supply free copies to the parties.