By Smt. C.S. Sulekha Beevi, President,

Facts:-

1. The patient Shahida who was the complainant's wife was admitted in first opposite party hospital on 17-10-2000 for delivery. She developed labour pains at about 10am the next morning. Though this matter was informed to third opposite party doctor, she behaved in a rude manner and did not pay necessary attention to the patient. At around 12pm patient was taken to the labour room and at about 12.15 PM she delivered a baby boy. Complainant was informed that the delivery was normal and that there was no complication. At about 2 PM second opposite party informed her uncle that there is bleeding and that the placenta was not yet expelled. Complainant was informed that he would have to take the patient to Kozhikkode Government Medical College to give blood transfusion and that she can be brought back the next day itself. A few minutes later third opposite party informed that an operation is necessary to remove the placenta. Complainant got worried by the conflicting versions of opposite parties. Sensing complication complainant barged into the labour room and then he saw third opposite party beating strongly on the stomach of his wife Shahida. Blood was pouring out of her and there was a bucketful of it below the bed. Though he wanted to take his wife to the Medical college no vehicle was available. Complainant then requested second opposite party to let his car to take the patient to Medical College. Second opposite party refused the same. With much difficulty complainant fetched a taxi and took the patient to Medical College. Though he asked opposite parties to accompany the patient, they refused. After much persuasion two nurses were send. While being taken to Medical College her condition was that her uterus was not fully inside. The doctors at Medical College complained of the delay in bringing the patient. Six bottles of blood was transfused. For almost a day and a half she was unconscious. On 21-10-2000 the patient died at Medical college Hospital. The cause of death stated in the death certificate was 'loss of blood'. It is stated that opposite parties claimed the complication to be a case of inversion uterus. Complainant alleges that timely and proper care was not given by second and third opposite parties. The lack of proper management resulted in the death of the patient. That the hospital does not have a gynecologist on it's call. That though complainant requested for copies of treatment records opposite party responded stating that the bill has not been settled. That though complainant settled the bill the records were not given to him. That second opposite party has registered a police complaint against the complainant alleging manhandling and damage to property of hospital. That a suit is also filed before Parappanangadi Munsiff Court for damages. That such cases are only retaliations against the complainant's request to obtain copies of treatment records. That due to negligence of opposite parties complainant became a widower and the child became motherless. Hence this complaint claiming 5 lakhs as compensation.

2. A joint version was filed by opposite parties. The allegations of negligence is specifically denied. Opposite parties admit that Shahida had come for antenatal checkup to third opposite party on 13-7-2000. All the subsequent antenatal checkups done at opposite party hospital are detailed in the version. That at 11.45 am on 17-10-2000 patient was admitted for safe confinement. She was given necessary enema. On 18-10-2000 there was no significant labour pains. As post dated pregnancy with favourable cervix and general condition of mother and faetus, induction labour was tried with intra cervical cerviprime injection. At 1.30 pm mildcontractions started and patient complained of pain. Third opposite party explained to the bystanders that these were not actual labour pains. 1% glucose through IV cannula was started. At 7.00 pm on per vaginal examination done by third opposite party it was found that cervix was effaced, 1 cm dilated, bag of membrane was bulging, ARM done, Liquor was clear. Contractions were mild and so pitocin 2.5 units in 5% glucose was started. Injection Anxol 2cc im was given. Patient developed regular contractions and faetal heart was normal. At 11.45 pm patient was shifted to labour room. On examination uterus contracting, Vx engaged, IH good, BP 120/80 mm Hg. PV—Vx.6—8 cm dilated, head at O' station. At 12.15 on 19-10-2000, patient delivered normally with right mediolateral epiosiotomy a male baby who cried soon after birth and weighed 2.7 kg. But with the delivery of the foetus the uterus inverted out with the attached placenta. The umbalical cord was notably short. The uterus with placenta was pushed inside under IV Anxol injection. And vagina packed tightly. Third opposite party then waited for the spontaneous expulsion of placenta. In 15 minutes placenta separated and expelled entire, bleeding was within normal limits. Injection Methergin IV given at 12.45. while third opposite party was waiting for expulsion of placenta second opposite party informed bystanders that in case placenta is not expelled patient will have to be taken to higher centre. After expulsion of placenta injection methergin was given. Since bleeding was within normal limits and BP and pulse were steady third opposite party informed the bystanders that there was no complication. Third opposite party observed the patient in the labour room. A small dimpling was palpated at the fundus. So third opposite party asked the complainant to come to the labour room and explained that uterus had not returned to it's normal size after delivery. Though there was no bleeding at that time, there was a chance of re-inversion, bleeding and state of shock. Further correction had to be done under anaesthesia and so the complainant was advised to take the patient to Medical College, Kozhikkode. Patient was taken at 1.45 am. The pulse and BP at that time was 90/mt and 100/60mm Hg. Two nurses accompanied with iv normal saline drip. Patient reached Medical College at 3.00 am. That utmost care and caution was taken in the treatment of the patient. There was no delay in referring the patient as alleged. That third opposite party has 18 years experience in obstetrics and has been practicing in the hospital for the last 16 years. The patient had inversion of uterus along with the delivery of the baby, which is a rare complication of delivery and this was corrected promptly. The allegations in the complaint are specifically denied as false by opposite party. It is stated that on 29-10-2000 at 6.30 pm the complainant Manzoor and one Siddique, Mohammedkutty and 15 others rushed to the hospital with deadly weapons and assaulted second opposite party and other staff of the Hospital. The casualty Room, Pharmacy, Treatment Room, General ward etc were completely damaged and stones were pelted on the front portion of the office. The matiz car No. KL-10J/2464 was completely destroyed. Criminal cases were registered by Tirurangadi police against the assailants. That these cases are pending before Judicial First Class Magistrate, Tirurangadi. Second opposite party had also filed civil suit OS-241/2000 against the assailants claiming compensation for the damages. The incident was on 29-10-2000 and complainant send his first letter only on 16-11-2000. That the complaint is only an after thought to escape from the above civil and criminal cases. That there is no medical deficiency on the part of opposite parties and that complainant is not entitled to any reliefs.

3. Evidence consists of the oral evidence of PW1 who is a witness examined on behalf of complainant. No documents marked for complainant. No evidence on the side of opposite party. Complainant and opposite party has not filed any affidavit in this case. Counsel for opposite party argued the matter on 08-5-2009. No arguments tendered from the side of complainant.

4. Points for consideration:-

(i) whether opposite parties have committed any medical deficiency.

(ii) If so reliefs and costs.

5. Point (i):-

The facts are not narrated again to avoid repetition. There is absolutely no evidence tendered on the side of complainant in support of the facts averred in the complaint. The only evidence put forward by the complainant is the oral evidence of PW1, Dr. Sajala Vimalraj who is an expert and postgraduate in gyanecology. She has deposed that the condition suffered by the patient in this case was inversion uterus. She has stated that inversion uterus has to be corrected immediately and that blood transfusion has to be done. She has also stated that in case of uterine inversion manual repositioning is first tried. She has deposed about the situation as under:

“Acute inversion occurs immediately after delivery of placenta. Death occurs from uterine inversion. The exact cause of uterine inversion is unknown. This condition is not always preventable. Shock and haemorrhage are prominent in this condition. In case of uterine inversion manual repositioning is first tried. This need not always be possible. Even after successfully manually repositioning the uterus. There is possibility of re-inversion. In such cases further correction has to be done under anaesthesia in operation theatre. There are other techniques which also can be employed. Inversion uterus is an accepted well documented complication of delivery”.

6. The evidence of PW1 substantiates the contentions put forward by opposite party in the version. It is clear that the patient died due to the condition of inversion of uterus after delivery. This situation as deposed by the expert is not always preventable and is a rare complication in delivery. Counsel for opposite party also relied on quotings from 'Williams Obstetrics' 22^nd edition. It is stated in page 833 as under:

1. “Placenta accreta may be implicated, although uterine inversion can occur without the placenta being so firmly adherent”.

2. “Uterine inversion is most often associated with immediate life-threatening haemorrhage, and without prompt treatment it may be fatal.”

From the averments in the version and from the evidence of PW1 it is brought out that opposite parties have applied the proper method and treatment to set right the emergency condition. Thereafter patient was referred to expert centre by third opposite party to prevent re-inverson and further complications. Second and third opposite parties have joined hands and worked to do their level best to manage the emergency situation during the course of treatment in their hospital. Surprisingly complainant has abandoned the case without even filing a proof affidavit to substantiate his contentions. No case of negligence or medical deficiency in service on the part of opposite parties is established or proved.

7. In the result we dismiss the complaint. We make no order as to costs.

Dated this 24th day of June, 2009.

Sd/-

C.S. SULEKHA BEEVI, PRESIDENT

Sd/-

MOHAMMED MUSTAFA KOOTHRADAN, Sd/-

MEMBER E. AYISHAKUTTY, MEMBER

APPENDIX

Witness examined on the side of the complainant : PW1

PW1 : Dr.Sajala Vimalraj, Obstetricial Gynaecologist, Calicut.

Documents marked on the side of the complainant : Nil

Witness examined on the side of the opposite parties : Nil

Documents marked on the side of the opposite parties : Nil

Sd/-

C.S. SULEKHA BEEVI, PRESIDENT

Sd/-

MOHAMMED MUSTAFA KOOTHRADAN, Sd/-

MEMBER E. AYISHAKUTTY, MEMBER