Mr. Th. Saimon, Hon’ble President (Acting):-  This is a Consumer Complaint case filed by the above named complainant under Section 17 of the Consumer Protection Act, 1986 and rules made thereunder, claiming amongst others for compensation amount of Rs. 97,20,000/- (Rupees ninety seven lakh twenty thousand only) for causing death of his wife late Mrs. Thokchom Ongbi Kheroda Devi, due to deficiency of service and medical negligence by the opposite parties jointly and severally.

On further advice of the doctors on duty, the deceased wife of the complainant visited RIMS Hospital on 04/07/2016, taking an OPD Registration ticket being no. RIMS16-0179900, and she underwent various medical tests and examinations, following which she was advised by the doctor on duty to get admitted in the Labour Room on the same day. At about 6.30 pm of the said day, i.e. on 04/07/2016, she was admitted in the Ante Natal Ward Unit – I MRD No. 105472, after payment of Rs. 10/- and Rs. 50/- respectively for admission vide CR No. RIMS16-01 80899. After the deceased Thokchom Ongbi Kheroda Devi was admitted with 38 weeks pregnancy, the doctor on duty on the said day informed her family members that she was completely normal. Later, on the next day, i.e. on 05/07/2016, the deceased Thokchom Ongbi Kheroda Devi, gave birth to a baby girl through normal delivery at about 8.30 pm, after which the baby girl was handed over to the complainant and his family members. However, after the normal delivery of the baby girl, deceased Thokchom Ongbi Kheroda Devi was profusely bleeding and was being kept in the labour room for observation and blood transfusion continued till 11.30 pm, and later she was rushed to the operation theatre at around 11.40 pm as her condition deteriorated. The complainant and his family members became curious of the health condition of deceased Thokchom Kheroda, however, they remained calm after being given positive responses by the doctors and nurses on duty on that day. Surprisingly, at about 11.45 pm, of the same day, i.e. on 05/07/2016, the doctors and nurses of the OT room asked the complainant to sign a paper and also asked some family members to be witness for conducting operation of the deceased Thokchom Ongbi Kheroda Devi. This came as a shock to the complainant and his family members as the deceased was reported to be quite normal prior to the delivery of the baby girl. In the meantime, the nurses and doctor on duty asked the complainant to bring some blankets and hot water bag for his late wife Thokchom Ongbi Kheroda Devi, which was immediately complied with. But later, at around 4.00 am of the next day, i.e. on 06/07/2016, to the utter shock and dismay of the complainant and his family members, the Senior Resident on duty informed that Thokchom Ongbi Kheroda Devi had expired. It is also presented as a fact of the present complaint case that following the untimely death of Thokchom Ongbi Kheroda Devi due to deficiency of service and medical negligence on the part of the doctors on duty and authority of RIMS Hospital, huge public outcry and protests from civil society organisations of Manipur spurted, demanding for conducting an inquiry into the death of Thokchom Ongbi Kheroda Devi, deceased wife of the complainant. An enquiry committee was thus constituted by RIMS authority vide order no. 12/P.ENQ/RIMSH/13/1942, dated 12/07/2016 under the following terms of reference:

1. To determine the condition of the deceased at the time of admission into RIMS hospital;
2. To find out the facts and circumstances leading to the death of Mrs. Th. Kheroda Devi and;
3. To find out if there have been any lapses on the part of the healthcare providers and for rectifications required, if any, in the future.

3.         It has been further presented that the complainant and his family members fully co-operated with the Enquiry committee by abiding all their instructions; However, the report of the said committee was never made available to the complainant, due to which an application under RTI act was filed by the younger brother of the complainant to the Deputy Director (ADM) & CPIO, RIMS on 30/08/2016, and copy of the report of the enquiry committee was furnished to the complainant where it was opined that there was negligence on the part of the O.P. Nos. 1, 2 and 3. Following the report, the complainant has filed and preferred the present complaint case against the O.P. Nos. 1 to 6, for payment of compensation to the tune of Rs. 97,20,000/- (Rupees ninety seven lakh twenty thousand only), for causing the death of his wife late Thokchom Ongbi Kheroda Devi.

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“Some lapses in discharging duty/responsibility were evident on the part of Dr. N. Yohen, Sr. Resident and Dr. L. Trinity, Registrar of Obstetrics & Gynaecology Department and Dr. K. Jina, Dr. Resident, Department of Anaesthesiology, RIMS. Their problem was underestimation of the seriousness of the patient and timely intervention thereof, lack of proper communication among the doctors including proper handing over of the patient (for Dr. N. Yohen, Dr. L. Trinity and PGs) and non-availability of Dr. K. Jina, Sr. Resident in the earlier part of anaesthetic cover for the EUA in the OT.”

6.         O.P Nos. 1 to 3 had filed their respective separate written statements in response to the Complaint case filed by the complainant whereas the O.Ps. 4 to 6 filed a joint written statement.

7.         The O.P. No. 1, in his written statement had categorically denied almost all the allegations of the complainant. The O.P. No. 1 denies that the allegation that Th. Kheroda Devi was profusely bleeding after the delivery. It is submitted that the O. P.  No 1 had never met the wife of the Complainant as she was examined by different doctors in the OPD. The O.P. no 1 met Mrs. Kheroda for the first time on 5^th of July, 2016 at around 10.30 am during ward round. She had a 7 years old baby girl through normal delivery and Lapchole operation before this pregnancy. Ultrasound before delivery shows IGUR/ Small Baby and Oligohydramnios / Less Liquor. Out of the four doctors in unit 1, only two doctors – Professor N.K Singh (Dr. Nabakishore Singh) and O.P No. 1, were there for the ward round that day (since  Dr. Bimol was on study leave and Dr. Pratima was on casual leave). Two of the doctors so present on that day have decided to induce her for normal delivery as she was 38 weeks and 4 days, baby was small and liquor was less clinically as well as by ultrasound and this has been explained to Th. Kheroda during the round. Moreover, Wednesday and Thursday i.e 6^th and 7^th of July 2016 were holidays for “Ratha Yatra and Eid” respectively. The O.P. No.1 had night duty on that day and he inserted the cerviprime gel himself to the deceased/patient in the labour room observation bed at 11.30 a.m. Then O.P.No.1 continued his remaining round of all the wards including special ward. At the end of the ward round 2(two) patients requiring caesarean section (CS) were prepared for CS.

It is further stated that as usual the O. P. No. 1 visited to see the operated cases in the Special Ward while coming for the night duty before reaching labour room if the o.p. No. 1 got stuck up in the labour room due to many emergencies or due to many emergency CS coming Up, the o.p. No. 1 would not be able to see already operated cases in time. When the O.P. No. 1 was in special ward to see the operated cases, the O.P. No. 1 was informed by the PG Doctors of the night shift that Mrs .Th. (O) Kheroda had mild bleeding and was about to deliver ( 8.20 pm ). Then, the O.P. No. 1 came through RIMS Operation Theatre, checking the status of the OT and thereafter, when the O.P. No. 1 reached the Labour room Mrs. Kheroda had delivered a baby girl and the PGs have started stitching episiotomy after giving oxytocies. The duty Doctors informed the O.P. No. 1 that bleeding was controlled and Mrs. Kheroda was stable at the moment. Then, the O.P. No. 1 called all the relatives of the [patients in the observation bed one by one and explained about the status of their respective patients which the O.P. No. 1 usually do and did the necessary counseling. The O.P. No. 1 then left for RIMS Emergency OT after the O.P. No. 1 was informed over the intercom by the PG doctors and by this time, Mrs. Kheroda was still inside the delivery room. Soon after, the O.P No. 1 attended one patient namely, Smt. W.  Ichan W/O.  Premjit of Singjamei who was the first patient upon which caesarean was done and continuously thereafter another patient, namely, Smt N. Ibethoi W/O Bishorjit of Naharup Pangong until 11.30 pm. Even though the O.P. No. 1 was occupied in the CS, O.P. No. 1 enquired  from  his  mobile  at  9.40 pm (to Dr Haelom) about the patient in labour room, which the O.P. No. 1 usually do , the PG (DR Haelom) called back at 9.55 pm and informed that  the previous CS case for trial (S. Anita of Manaingkhol of unit IV) assessed by the O.P. No. 1  seems to have a baby of more than average size and might require CS   and they were sending her ( Anita ) to OT. Till the time of delivery of second baby in the OT there was no call from the labour room over the mobile or intercom.  During that time, while the O.P. No. 1 was engaged in the emergency CS of Ibethoi, they informed about Mrs. Kheroda over the mobile at around 11pm.  As the O.P. No. 1 was engaged with the emergency life saving caeserian, the O.P. No. 1 asked his assistant to de-scrub and enquire in detail about the case over intercom. In response to the query,   PG Doctor assisting the O.P. No. 1 informed that Mrs Kheroda is bleeding per vaginum (PV)/post partum haemorrhage (PPH), with pulse rate of 136/ 140/ min and blood pressure (BP) of 90/60, therefore the O.P. No. 1 asked his assistant to inform labour room Doctors to shift Kheroda to OT as she required examination  under anaesthesia as she was trickling and they have already started the second unit of blood. After the second CS was over the O.P. No. 1 called up labour room personally to confirm whether the PG had shifted Mrs Kheroda to OT. The third case (Anita of Manaingkhol) of unit IV with previous cesarean whom the O.P. No. 1 thought for trial for VBAC reached OT just after the second case of the night shift was started and she was screaming with labour pain in OT while the O.P. No. 1 was operating the second case (Ibethoi). However, after examination by the Assistant, Doctor on duty including the O.P. No. 1 felt that she would deliver vaginally so the O.P. No. 1 asked to shift her to Gynae OT and Prepare for instrumental / ventouse delivery and the O.P. No. 1 delivered the baby by ventouse in OT at 11.39 pm. In the meanwhile, at around 11.45 pm , Mrs Kheroda has reached OT and immediately the O.P. No. 1 examined Kheroda and she was conscious enough to respond to the queries made by the O.P. No.1, by the time pulse was palpable and BP was also recordable.   However there was trickling of blood through the vaginal packing, the O.P. No. 1 felt that she required examination under anesthesia (EUA)/ Laparatomy and Hysterectomy. So, the O.P. No. 1 informed the Unit Head Prof.  NK Singh without delay as she was booked case of unit 1 admitted on Monday (4.7.2016).

            It is also further stated that thereafter Prof. NK Singh and the O.P. No. 1 examined  Kheroda  together  under  general  anesthesia (GA), there was no  active  bleeding  after  the  vaginal packings were removed,  the stitches on  the cervix (left Cervical tear)  and the  episiotomy were intact.  On exploring the uterine cavity, minimal/negligible blood clots were found and BP has improved during the procedure with no more bleeding, so decision was taken for uterine and vaginal packing and thought there was no need for laparotomy. Third  and  fourth  unit  of  PRBCs  were  transfused  during  the  procedure.  As the Vital  improved  and there were no further bleeding on the OT table, O.P. No. 1 and his senior consultant have decided to inform the relatives that  patient  was  improving  as anesthetist were about to exudates the patient as they also probably felt she has recovered from the procedure and  anesthesia. The patient was even asked to open her eyes and protrude her tongue at that moment.  However, after  informing  the  relatives  about the same,  and as  the O.P. No. 1  re-entered the operation room,  it was  found  that Kheroda has been reintubated and there  tachycardia upto 180/ min and BP dropped leading to the cardiac arrest. Cardioplumonary resuscitation (CPR) was started immediately by the anaesthetist, pulse became feeble and BP was recorded even though low. Again, BP became unrecordable. In such a condition when the patient was to  be   given  cardioversion  /  DC  Shock  basically,  however  it was found  out  that  Defibrillator in  the  OT  was not  functioning / working.  Again the Technician brought another  Defibrillator which unfortunately had the same  condition  i.e  non- functional.   Thereafter,  deponent‘s   assistant  himself went to the Intensive care unit  (ICU)  and  brought  a  working  Defibrillator,  after which Mrs Kheroada was  given  Dc  Shock.   During the  process  of  finding  a  functional  Defibrillator  a  reasonable time   was  spent. It was at that time the SR of Anaesthesiolgy came to assist them.   There was little improvement but Kheroda had not recovered completely out of Anaesthesia. It was  at  this  point that the Anaesthesist decided  to keep her  in  the  ICU  with  ventilator  support  considering  the  condition  of the patient.  The relatives were explained about the present condition with the prognosis and also the need for shifting to ICU. In  the ICU  there  was  not much improvement  and  the prognosis  was explained  from  time  to time  by  the  O.Ps.  team  hoping  that  only  prayer or a miracle could  help  at  this point because whatever the doctors on duty  could  do had already  been done.  The Doctor  on  duty  was  saddened by the  fact  that inspite  of 4 PRBCs, 2 FFPs, IV Fluid,  Inotropes  and  other  resuscitative  measures  taken by the whole team  Kheroda failed  respond  to  the  treatment  and  she  was  declared dead at 4.30  am  of 6.7.2016  and relative had also  been informed  at  this  moment  that  the  team  could  not  save  her  inspite  of  best  efforts.

With the above stated allegations/ averments the OP No. 1 had sought for dismissal of the complaint.

8.         The O.P. No. 2, in his written statement had categorically denied all the allegations of the complainant case and  stated that at about 8.30 pm of 5/07/2016, a baby girl was born by the victim (Th. Kheroda Devi) with normal delivery and her family were informed by a nurse on duty but the victim was profusely bleeding after delivery and kept in the labour room for observation by giving blood till 11.30 pm and thereafter, the victim was referred to the operation theatre at around 11.40 pm as the condition of the victim got deteriorated .

Further, it is submitted that the OP No. 2 was on duty up to 8.00pm of 5/07/2016 and the victim had given birth at 8.30 pm under the supervision by another doctor who was on duty at the relevant point of time and since the problem of bleeding to the victim started after delivery of the baby where the OP No. 2 is not at all connected.

          Again it is submitted that the progress of labour of the victim was adequately normal as the cervical dilatation was found at 4 cm at 7pm, 5cm at 7.50 pm of 5/7/2016 and Meconium Staining of liquor was also noted as early as 7pm which was found no abnormality in the fetal heart rate or rhythm during labour and a healthy female child was delivered who cried immediately at birth was an example of no signs of fetal distress.

On the same day of 5/7/2016 at about 7.55 pm, the O.P. No. 2 was managing another patient in High Dependency Unit, situate adjacent to labour ward, who had no urine output following caesarean delivery complicated by postpartum haemorrhage, in consultation with the unit Associate Professor Dr. R.K Praneshwari and corrective measure were being taken as per her advice. The OP No.2 was informed by one post graduate trainee Dr. Dinesh Kumar Singh at about 8 pm that the victim (TH.  Kheroda) had about 20 ml of bleeding, the OP No. 2 immediately rushed to examine the victim but the victim was found to be at normal pulse rate & blood pressure, regular urine contraction and normal heart rate and no further bleeding.  The O.P. No.2 asked Dr. Dinesh Singh to call and asked DR. Trinity about the bleeding which was duly done till 8.00pm of 5/7/2016 and at the relevant point of time,   Dr. Trinity Meetei was already in the Hospital premise and said DR. Trinity who on duty after the O.P. No. 2 completed his duty at 8.00pm and left the hospital.  No further bleeding was informed to the OP NO.2 after 8.00pm. Thus, the O.P. No.2 had followed all the norms in the management of the victim’s labour and handed over the case properly to his successor and as such neither any deliberate lapse nor lack of duty arose from the part of the OP No.2.

            It is further submitted that on submitting the representation dated 22/8/2016 which was addressed to the director, RIMS, there was typical error in the statement of the OP No.2 regarding the word “ Male Child “ which was unintentional on the part of the O.P. No. 2 and further, the O.P. No. 2 was not on the duty at the time of delivery of child to the victim and  at  least  two  three   babies were given birth in a day at RIMS Hospital and as a result of it, there might be confusion on the part of the OP No. 2 in the said statement which was unintentional.

            It is submitted that the OP No. 2 did proper assessment to the victim. At around 8.00 p.m, the OP No.2 was informed by one post graduate doctor regarding the vaginal bleeding of victim had about 20ml. The O.P. No. 2 along with the post graduate Doctor examined the victim.  The victim was well conscious, cooperative and well oriented with pulse of about 90/m with good pulse volume (BP 110/60 mm Hg).  Uterus was relaxing between contractions and FHR was about 140/m and found regular.  No active vaginal bleeding was noted at that time.  Having established feto-material well, the O.P. No. 2 signed off his duty after having informed the Post Graduate Doctor to consult with the Dr. Trinity Meetei, the Senior Resident on duty, if any further bleeding continued to the victim.

It is further submitted that at the time of assessment of the victim by the OP No.2, there was passage of thick meconium stained liquor and the victim was found to be good labour progress as cervical dilatation was progressing of 4 cm at 7 pm, 5cm at 7.50 cm and as such normal delivery was carried out at 8.30 pm. As per the document submitted by the complainant found at annexure A/6 page 23, there was thin meconium stained liquor which was very much normal to deliver a baby but unfortunately, at the right side of the said document it was made written as thick meconium stained liquor in the form of manipulation in different hand writing for causing accusation on the part to O.P. No. 2. All such acts of manipulation may be done by the O.P. Nos. 4, 5, and 6 in consultations with enquiry committee in order to harass the OP No.2 who having been discharging his duty with due care and cautions. As a result of it there was no lack of duty or mere negligence on the part of the OP No.2.

With the above stated allegations/ averments the OP No. 2 had sought for dismissal of the complaint.

9.         The O.P. No. 3, in her written statement had categorically denied almost all the allegations of the complainant. On 5-07-2016 her duty was at ICU and at about 11.50 pm she got a call from her JR in OT (Dr. Mrinal) about a patient namely Th. Kheroda Devi, 34 years who had normal  vaginal delivery  at 8:26 pm with  the   Diagnosis of G3P1  + 0 + 1 with atonic and traumatic PPH in shock planned under GA (General  Anaesthesia).

Thereafter on examination, thepatient had BP around 70/40 (Palpatory 60), PR 146/min, RR 28/min. The general condition of the patient was very weak, she had marked pallor (Paper white). As per record i.e beforedelivery herHBwasonly8.4 gm% Blood was not transfused or arrangedbeforedeliverysoanemia wasnotcorrected. Twolinewere alreadysecuredwith18 GCannulas, 1 RL (10 Usyntocinon) + 1 unit of PRBC were givenafterdelivery(almost3.2Lfluid).Despitegiving the fluidsandblood, theBP was stillpalpatory60, soexcessbleedingsuperimposed withanaemiahasbeendocumented.Shealsoinformedtheconsultantondutyataround12: 05am

It is submitted that sinceshe was busy in handling the above patients in the ICU , she advised her JR(Dr.Luckson)post MD who had already passed out last month to take a high risk consentwith the death on the table,explained the conditionof the patient to the patientparty.She too gaveclearinstruction to start the case whenthe BPhas been raised toat least systolic 90 after starting injection dopamine 2 ample in 500ml NS @ 10 microgram/Kg/min. At that point of time, giving GA was the only option, securing airway was also very important.

It is furthersubmitted that she was verybusyin ICUand could notleavetheICUimmediatelyasthere wascasesofemergencyonboth thesides. Soin ordertosavethe time,sheadvisedtogoaheadtoherJR(Dr. Luckson), post MD. If she immediatelyleftthepatientinICU,the patientinthe ICUcouldhavediedandthe numberofdeathsmightbemore.Sosheadvisedtogiveoxygen100%, druginj Ketamine60 mg,injmidazolam 1 mg and succinylcholine 75 mgandairwaywassecured.02+ N20, inj atracurium 10 mg were given for maintenance. The drugs and the dose were appropriate for the patient and was given only 1/3 – 1/2 of the actual dose. Blood was flushed fast, the vital started improving, BP increasing and HR decreasing.This is not the firsttime,her JRSdealwithsuchcases,theyhavemanagedlotsofsurgeryandgynaepatientscomingin shockandsincesheknewthecompetencyofherteam,shetoldthemtogoaheadwiththeanaesthesia.

10.       The O.P. No. 3 again, further submitted that she  was very  much  available  in  the ICU  and  told  her JRS  in OT  that she would  be coming  after  managing the  patients  in the  ICU   as  the  vitals  of  Kheroda were settled  down.  After managing all her cases in the ICU, she came to OT immediately.  The examination under anaesthesia was near completion.  The  surgical  team  just  repaired  the  cervical  tear,  did  vaginal  packing   and B/L  (bilateral)  uterine  massage  was  done.  They did not    explore the abdomen.   At  the  end  of the  procedure  the  patients  vitals  were  stable  with  BP  110/71,  HR  130/min,   SPO2   100%.  However, the patient was still pale (+++).   When  the  spontaneous  effort  of  the  patient  came,   patient  started  following  commands,  suction  was  done  and  they  extubated  the  patient  at/ around      1:10  am.   100%  O2 was  being  given  and  they  observed  the  patient  for  some  time.

At around 1:15 am the BP suddenly dropped to 80/50 and the oxygen saturated drop to 90%.Therespiratorypatternwasnotgoodandwithina minutetheyintubated her.The tube was ausculatedbilaterallyandfixed.However,afterfewminutesmay bearound1:20amtheBP startedfalling andsuddenly,the patientwaspulse less.The SPO2 also started falling as there was no perfusion. The vitals did not improve much thereafter.Itlookedlikethepatienthaddecompensatedheartfailure duetohaemorrhagicshock. ATaround1:30amCPRstartedandInjAdrenaline 1 mgwasalsogiven. The ECG monitor started showing polymorphic ventricular tachycardia with HR 190/min Inj. Loxicard (ligonocaine) 3 ml was given and CPR continued.Inj Norad (noradrenaline) 2 amp in 500ml NS @ 8-10 U drops per min was also started.The dose of dopamine was also increased to 15ug/kg/min. CPRcontinued, HR was around 180/min and BP was still recordable. CPR continued Inj adrenaline was 1 mg given. DC (direct current-defibrillator) shock with 200j was given and CPR continued.Injection Sodium bicarbonate 2 was also given.CPR continued and ventricular defibrillator was seen on ECG monitor and DC shock with 300j wasgiven at/about 2:20 am.On examination pupils (R) side was mid dilated and (L) side sluggishly reacting to light.The pulse was still feeble, HR around 168/min (monitor), BP around 56mmHg (palpatory).She discussed with the surgical team Dr. Trinity andDr. Nabakishore that the outcome of the patient wasuncertainbutafter throughdiscussion with the surgicalteam forfurther ventilator and inotropic support, they shifted thepatient in ICUat / about 2:30am. The patient was received in the ICU at/ about 2:40 am and connected to ventilator on SIMV-VCmodewith tidal volume 330 ml, PEEP 6, PS10, RR 16/min. Inj Nodadrenaline and Inj Dopamine was still going on.At that time, the patient’s BP was systolic 50 mmHg, HR 160/min. At/ about 4:15 am the BP and the pulse of the patient became unrecordable and patient had cardiac arrest. CPR again started, Inj.Adrenaline 1 mg given. DC shock 200j was given and Inj.Adrenaline repeated again.The pupils were fixed and dilated and patient was in asystole. Despite their constant efforts they could not save the patient.Death was declared at 4:30 am of 06-07-2016.

11.       The O.P. No. 3 again, further submitted that since she  was  discharging her  duty  in  two  units  i.e one  in the  ICU  and  another  in the  OT  in one time.  On that  day there  are  many  serious  patients  in the  ICU  and  her  presence  was  very  much  necessary  at that time  that  is  why in order  to  save  the  time  and  lives  of  the  patient  in  the ICU, She  advised  her  (Dr. Luckson), post  MD to do the needful.  She also  informed in case of  any complicacy  please inform her immediately  so  that she  may  settle  the  matter. However, no complicacy was there at the time of procedure.  Complicacy was started only when the operation procedure was ended in her presence.

With the above stated allegations/ averments the OP No. 3 had sought for dismissal of the complaint.

12.       The O.P. Nos. 4, 5 and 6 filed a joint written statement and had raised a preliminary Issue of maintainability on the ground that the complainant is not a consumer under the Consumer Protection Act, 1986.

13.       The O.P. No. 4, 5 and 6 further submit that:-

1. The Hospital service rendered to the patient is non-profitable.
2. There is no charge to patients for staying in the casualty or in the wards.
3. No charge is levied by treating doctor either directly or indirectly.
4. No charge for nursing care.
5. No charge for treating including minor or major surgical operations.
6. No charge for water supply, toilet, etc. instead drinking water is made available free for the patient.
7. No charge on meals (lunch and dinner) supplied/ catered to the patients.
8. No charge on medicines and other items supplied by the Hospital.
9. Only nominal fee on registration Rs 10/- and admission Rs 50/- is taken as token from patient.
10. Only nominal charges for investigation like X- Rays, Blood, & other fluid / Specimen examinations.
11. Other nominal charges for CT scan, MRI, etc. (as in other Government Hospital in the country).
12. No separate fee/charge for intensive care unit (ICU) and intensive coronary care unit (ICCU).
13. No charge for delivery baby either by normal route or by operation, and
14. All consultations and treatment in the Hospital are  “  free of cost “

14.       The O.P. No. 4, 5 and 6 further submit that the Complainant failed to implead Ministry of Health & family Welfare, Government of India or its representative as party in the Complaint case, thus the complaint case not maintainable for want of impleading necessary party.

            With the above stated allegations/ averments the OP Nos. 4, 5 and 6 had sought for dismissal of the complaint.

15.       The complainant has filed and exhibited the following documents and they are:-

1. Exhibit P/1 is the examination in chief of the complainant. Exhibit P1/1 is his signature
2. Exhibit P/2 is the complaint petition. Exhibit P2/1 and P2/3 are signatures of the complainant.
3. Exhibit P/3 is the Xerox copy of the order dated 6.7.2016 for constituting the enquiry committee by the Medical Superintendent (RIMS).
4. Exhibit P/4 is the Xerox copy of the forwarding letter dated 8.7.2016 for submission of enquiry report to the Medical Superintendent (RIMS) Hospital, Imphal by the Chairman, Enquiry Committee.
5. Exhibit P/5 is the Xerox copy of the report of the enquiry committee dated 6.7.2016.
6. Exhibit P/6 is the Xerox copy of the forwarding letter dated 8.7.2016 for submission of the report of enquiry committee dated 8.7.2016 by the Superintendent, RIMS to the Director, RIMS.
7. Exhibit P/7 is the Xerox copy of the proceeding of the meeting of the enquiry committee held on 8.7.2016.
8. Exhibit P/8 is the Xerox copy of the suspension order of O.P No. 1 by the Director (RIMS) Hospital dated 11.7.2016.
9. Exhibit P/9 is the Xerox copy of the order dated 12.7.2016 of the Medical Superintendent (RIMS) hospital, Imphal for constituting the committee for inquiring them into the alleged negligence of management of Smt. Th. Kheroda Devi.
10. Exhibit P/10 is the Xerox copy of the order dated 13.7.2016 passed by the Medical Superintendent (RIMS) Hospital, Imphal Modifying/altering the members of the committee.
11. Exhibit P/11 is the Xerox copy of the order dated 20.7.2016 of the Medical Superintendent (RIMS) Hospital adding two more members to the enquiry committee.
12. Exhibit P/12 is the Xerox copy of the letter dated 22.7.2016 for extension of time for submission of the enquiry report.
13. Exhibit P/13 is the Xerox copy of the notice dated 29.7.2016 issued to me for appearing before the Committee on 1^st August, 2016.
14. Exhibit P/14 is the Xerox copy of the notice dated 29.7.2016 issued to one Th. Suresh for appearing before the committee on 1^st August, 2016.
15. Exhibit P/15 is the Xerox copy of the letter at 30^th July, 2016 of the Chairman enquiry committee for extension of time for submission of his report by one more week.
16. Exhibit P/16 is the Xerox copy of the (RTI) Application filed by one Th. Subhaschandra for a copy of the details of the comprehensive enquiry committee and action taken report by the authority under RTI Act, 2005.
17. Exhibit P/17 is the Xerox copy of the forwarding letter for furnishing copies of the enquiry report and action taken report to one Th. Subhaschandra Singh.
18. Exhibit P/18 is the enquiry report furnished to Th. Subhaschandra as per application under RTI Act, 2005.
19. Exhibit P/19 is the Xerox copy of the document relating to the treatment of Th. Kheroda Devi and verified by the Medical Record Officer, RIMS.
20. Exhibit P/20 is the original certificate of salary sheet of late Naoroibam Kheroda Devi by Camps’ English Academy, Luwangsangbam.
21. Exhibit P/21 is the Xerox copy of the disability certificate issued by the State Medical Board.
22. Exhibit P/22 is the original copy of the payment receipt for admission of treatment in RIMS Hospital, Imphal dated 4.7.2016.

the O.P No. 1 had produced and exhibited the following documents:-

1. Exhibit C/2 is the forwarding letter dated 27.03.2017 submitted by Director (Admn) in-Charge RIMS, Imphal to Dr. L. Trinity Meetei.
2. Exhibit C/3 is the histopathology report dated 25.07.2016
3. Exhibit C/4 is the postmortem report of Smt. Th. Kheroda devi dated 25.07 2016.
4. Exhibit C/5 is the written statement of O.P No. 1 submitted to the Chairman Enquiry Committee (second enquiry) constituted by RIMS authority on the death of Smt. Th. Kheroda Devi.
5. Exhibit C/6 is the written statement of O.P No. 1 dated submitted to the first enquiry committee constituted vide order of the Medical Superintendent, RIMS, Imphal dated 06.07.2016.
6. Exhibit C/7 is the statement of O.P No. 1 recorded by the second enquiry committee constituted vide order of the Medical Superintendent, RIMS, Imphal dated 12.07.2016.

The O.P No. 2 had also produced and exhibited the following documents;

1. Exhibit C/12 is the is the Xerox copy of some page of the Case sheet of the patient, Smt. Th. Kheroda Devi which was recorded at around 7:00 p.m. of 5^th July, 2016 and Exhibit C/12 consists of 5 pages.

      The OP Nos. 3, 4 5 & 6 did not file any documents

16.    After hearing the submissions and perusal of the pleadings of the complainant and the O.Ps No. 1 to 6, this commission has framed the following issues for better adjudication of the present Complaint Case in hand and they are:-

ISSUES

1. Whether the Complainant is a consumer or not?

2. Whether the Complaint petition is maintainable or not?

3. Whether there was any negligence on the part of the respondents in the course of diagnosis and treatment of the deceased Mrs. Th. Kheroda at RIMS?
4. If there is a cause of action?

5. Whether the Complainant is entitled to any relief under the Consumer Protection Act, 1986 and Rules thereof, and if so, what will be the nature of relief and amount of compensation to be granted by Commission?

17.    The complainant had produced and examined 6 (six) witnesses and they are:-

1. Th. Somendro, the complainant (PW 1)
2. Thokchom Suresh Singh (P.W. No. 2)
3. Thokchom Ongbi Ibeyaima Devi (P.W. No. 3)
4. Huidrom Iboyaima (P.W. No. 4)
5. Thokchom Shubashchandra (P.W. No. 5)
6. Thokchom (O) Jamuna Devi (P.W. No. 6)

18.    The Opp. Parties produced and examined 7 (seven) witnesses and they are:-

1. Dr. L. Trinity, the Opp. No.1  (DW 1)
2. Dr. N. Nabakishore Singh (D.W. No. 2)
3. Kh. Pradeepkumar Singh.(D.W. No. 3)
4. Dr. N. Yohen Singh (D.W. No. 4)
5. Dr. K. Neelam Devi (D.W. No. 5)
6. Dr. Md. Farid Mubaraque(D.W. No. 6)
7. Dr. Konsam Jina Devi (D.W. No.7)
8. Dr. Feiga Luckson Gangmei (D.W. No.8)

         It may be stated that (i) Shri Dr. K. Lekhachandra Sharma marked as P.W No.7 and (ii) Shri Dr. Th. Tomcha Singh marked as P.W. No.8 were examined on being called for examination by the Commission.

EVIDENCE

19.    The testimonies of the PWs are briefly reproduced hereunder:-

         The complainant as P.W. No. 1 deposed almost all the allegations made by him in the complaint in the form of examination-in-chief by way of affidavit (Exhibit P/1) as his evidence. He exhibited the documents enclosed in the complaint which have been marked from exhibit P/2 to exhibit P/22. During cross examination by the learned counsel for Opp. No. 1 the P.W. No. 1 deposed that on the next day of admission to the hospital, his deceased wife was examined by Dr. L. Trinity, the Opp. No. 1 along with his senior and his team and they informed him that his deceased wife was having normal health. The P.W. No. 1 denied the suggestion that Opp. No. 1 regularly informed the patient party including himself about the health condition of his deceased wife. During the period after delivery and operation on 05/07/2016. P.W. No. 1 denied that he put his signature on the undertaking after knowing contents of the same. P.W. No. 1 admitted that Opp. No. 1 conducted the operation on his deceased wife on 05/07/2016 at 11.45pm.

         During cross examination by the learned counsel for Opp. No. 2, the P.W. No. 1 deposed that he has no knowledge whether Opp. No. 2 namely Dr. N. Yohen was present at the time of  delivery given by his deceased wife.

         Again during cross examination by the learned counsel for Opp. No. 3, the P.W. No. 1 deposed that it is a false statement that on 05/07/2016 at about 11.45 pm. at Operation theatre room, Doctors and Nurses on duty searched him and that they asked him to sign his signature in a plain paper and they asked him to make his family members as witnesses. P.W.  No. 1 further stated that the growth salary of his deceased wife was Rs. 6242 /- (Rupees Six thousand two hundred fortytwo) and net salary of his deceased wife after deduction may be estimated at about Rs. 5000/-per month.

         During cross examination by the learned counsel for Opp. Nos. 4, 5 and 6 the P.W. No. 1 denied the suggestion that there was no medical negligence during treatment of his deceased wife at RIMS Hospital. He also denied the suggestion that Doctors at RIMS had given information to him about the serious condition of his wife after the delivery.

         The  P.W.  No. 2 namely Thokchom Suresh also gave similar version supporting the evidence given by the P.W. No. 1.

         During cross examination by the learned counsel for Opp. No. 1 the P.W. No. 1 denied that at the time of delivery of baby girl by his  sister-in-law (deceased patient), Dr. L. Trinity, Opp. No.1 was present in the operation theatre. He also denied the suggestion that prior to the operation the Opp. No. 1 informed the condition of the patient to the patient party.

         During cross examination of P.W. No. 2 by the learned counsel for Opp. No. 2, 3, 4, 5 and 6 nothing material could be contradicted.

         It may be stated that during examination-in-chief, P.W. Nos. 3 to P.W. No 8, had almost given similar version supporting the evidence given by P.W. No. 8.

20.    The Opp. No. 1 Dr. L. Trinity as D.W. No. 1 in his examination-in-chief deposed that on 05/07/2016 at around 10.30 am. in course of normal ward round, he alongwith unit head namely Professor Dr. Nabakishore Singh had examined the deceased wife of the complainant who was admitted for the first time in the ante Natal Ward of RIMS in the evening of previous day i.e., on 04/07/2016. The D.W. No. 1 made his deposition in the same version in reference to the statements in his written statement. The D.W. No. 1 exhibited the examination-in-chief as Exhibit C/1. He also exhibited the documents enclosed in his Written Statement as Exhibits C/2 to Exhibit C/8.

         During cross examination by the learned counsel for complainant D.W. No.1 denied the suggestion that the call from Dr. Dineshkumar was on the request of Dr. yohen, Opp.  No. 2 to inform him about the condition of deceased patient who had bleeding of about 20 ml. D.W. No. 1 stated that there was no proper handing over of charges from Opp. No. 2 to him on 05/07/2016 at the time of taking over night shift. The post mortem report that “final opinion: the death could be due to hypovolumic shock and acute renal failure resulting from intrapratum haemorrhage due to cervical arteriovenous malformation following normal vaginal devlivery.” Is only a probable cause for the death of the patient, Smt. Kheroda Devi. The D.W. No. 1 denied the suggestion that if there had been Laparotomy/ Hysterectomy (operation), the deceased patient would have survived. As the deceased patient had no bleeding for the last 9 (nine) months of her pregnancy, they did not aspect that she might be suffering from cervical AV malformation. D.W.No. 1 denied the suggestion that after normal delivery the deceased patient had excessive bleeding. D.W. No. 1 admitted that the condition of the deceased patient got suddenly deteriorated in as much as Tachycardia was upto 180 per minute and her blood pressure dropped leading to Cardiac arrest. The witness deposed that to check whether Defibrillator was working or not inside the operation theatre was look out of the anesthesia and Opp. No.3 was not inside the operation theatre while checking the Defibrillator. The D.W. No. 1 also denied the suggestion that the wearing apparel i.e,. Phanek was changed 4/5 times during the period from 8.30 to 11 pm of 05/07/2016 and that deceased patient expired at 11 pm of 05/07/2016.

         During cross examination by the learned counsel for Opp. Nos. 2 to 6, nothing material could be contradicted in reference to the statements given by the Opp. No. 1 in his examination in chief.

21.    Dr. N. Nabakishore Singh, D.W. No. 2 gave his examination-in-chief almost in the same line like D.W. No. 1.  During cross examination D.W. No. 2 deposed that he and Opp. Nos. 1 & 3 jointly decided for undergoing normal delivery of the patient Kheroda Devi. He also deposed that he did not give any special instruction to Opp. No. 1 to go to special ward then to the general ward. D.W. No. 2 denied the suggestion that the cause of death of the deceased patient was because of Vaginal delivery. Defibrillator is a life saving machine and is essentially required in the operation theatre. And that he did not see Dr. K. Jina (Opp. No. 3) at the time he entered inside the O.T. but he saw her at the time of giving D.C. Shock to the deceased patient inside the O.T.  on 05/07/2016. D.C. shock is normally applied to a patient when the condition is very serious. D.W. No.2 deposed that after taking the deceased  patient inside the O.T. they started examination of vaginal wall, cervis and episiotomy wound and any bleeding from uterus. As there was no bleeding they asked anesthetist to observe the patient for another few minutes, by that time, the blood pressure was coming up, so they decided not to go help for any surgery/ laparatomy.

Dr. Kh. Pradeepkumar Singh, D.W. No. 3 conducted the post mortem examination over the dead body of Thokchom Kheroda Devi on 12/07/2016 at around 11.50 am. During cross examination D.W. No. 3 stated that he had never come across the case of cervical Arterio-venous malformation in the history of RIMS since his service as the assistant Professor in the Department of Forensic Medicine at RIMS, Imphal except the present case and the case is also a very rare one. During cross examination nothing material could be shaken.

22.    Dr. N. Yohen Opp. No. 2 as D.W. No. 4 gave his examination-in-chief almost in the same version as given by Opp. No. 1 and nothing material could be found out during cross examination. Similarly Dr. K. Neelam as D.W. No. 5, Dr. Md. Farid Mubaraque as D.W. No. 6 were examined as witnesses produced on behalf of Dr. N. Yohen, Opp. No. 2. D.W. Nos. 5 & 6 gave almost similar version supporting the case of Opp. No. 2.

         Dr. Konsam Jina, Opp. No. 3 as D.W. No. 7 gave in her examination stated that on 05/07/2016 she did not personally attend the deceased patient namely Th. Kheroda Devi for examination.  Dr.Feiga Luckson Gangmei as D.W. No. 8 as witness of  Opp. No. 3 deposed that Dr. K Jina telephonically instructed him the medication to be prescribed to late Th. Kheroda Devi on 05/07/2016 when Dr. Jina  was covering at ICU, RIMS and that  on 05/07/2016 Dr. K. Jina, Opp. No.3 was not present at the  time of starting the operation of late Th. Kheroda Devi.

FINDINGS AND OBSERVATIONS

23.       The complainant as P.W. No.1exhibited documents relating to the treatment of Th. Kheroda Devi which are verified by Medical Record Officer, RIMS and issued by the competent authority of RIMS as Exhibit P/19. The factum of treatment of complainant’s wife namely late Th. Kheroda Devi at RIMS since 12.11.2015 till her death on 06.07.2016 has not been denied by the OPs during evidence. Further, the factum of admission of the deceased patient at RIMS by paying Rs.50/- vide ANW-I M.R.D. on 04.07.2016(Exhibit-P/22) on the advise of the treating doctors has also not been denied by the O.Ps. and summon witnesses who were examined as P.W. No.7 and 8.  The deceased patient had also undergone various medical tests on different dates as part of the treatment on payment of nominal charges at RIMS which the O.Ps have not denied either in their pleadings or during evidence. Some of the tests were conducted at private laboratories by paying requisite charges since the said tests were of urgent nature.

      As discussed above, the complainant’s wife had hired or availed the service of RIMS by paying charges at the time of admission in the ward and also by paying charges for conducting various tests during the period of treatment. The complainant also purchased the blood required and other medicines during the operation. In other words, the wife of the complainant availed service of the RIMS on payment.

24.           Regarding the contention of the O.Ps. that medical treatment to the complainant’s wife at RIMS, Imphal was done free of charge and she was not required to make any payment of any professional service or any sort of medical treatment except token charges for registration etc., we are of the view that RIMS have wards such as General ward, ICU, Special Ward, Deluxe Ward, etc. in case of Special wards and Deluxe Ward hefty fees are charged. It can be added that RIMS provides General wards, ICU etc. free of cost for the poor and needy. On the other hand RIMS also charges hefty fees for patients staying in Special wards and Deluxe wards. Further in the written argument of the O.P. Nos. 4, 5 & 6, it is stated that nominal charge is taken for investigation like X-rays, Blood & other fluid/specimen examinations. The P.W. No.1 had exhibited documents at Ext- P/19 showing that tests were conducted at RIMS Hospital by paying fees.

25.           The Apex Court in the case of “In Indian Medical Association vs V.P Santha & Ors reported in AIR 1996 SC 550 AND In Niveditta Singh vs dr. Asha bharti & Ors reported in LL 2021 SC 721” it was held that a medical officer who is employed in a hospital renders service on behalf of the hospital administration and if the service as rendered by the hospital free of cost, does not fall within the ambit of S. 2 (1) (o) of the Consumer Protection Act.

27.           The Apex court in Balram Prasad vs Kunal Saha & Ors. (2014) 1 SCC 384 after considering the earlier decision of the apex Court in Savita Garg v National heart Institute (2004) 8 SCC 56) and in Malay Kumar Ganguly case ((2009) 9 SCC 221) held that doctors cannot escape the liability for medical negligence only on the ground that he did not charge any fee. Paras 76 and 77 of the SCC in Balram Prasad’s case (supra) read as follow;

“76.     The appellant doctors Dr. Sukumar Mukherjee and Dr. Baidyanath Haldar have attempted to claim in their respective appeals that they cannot be penalized with compensation because they did not charge any fee for treatment of the deceased. Such acclaim has no legal basis as in view of the categorical observation made by this Court in Savita Garg v National Heart Institute (2004) 8 SCC 56) and in Malay Kumar Ganguly case ((2009) 9 SCC 221) wherein this court has categorically stated that the aforesaid principle in  Savita Gargcase ((2004) 8 SCC 56) applies to the present case also insofar as it answers the contentions raise before us that the three senior doctors did not charge any professional fees.

77.       Further, it is contended by the claimant that from a moral and ethical perspective, a doctor cannot escape liability for causing death of a patient from medical negligence on the ground that he did not charge any fee. If that was true, poor patients who are sometimes treated for free and patients in many charitable hospitals would be killed with impunity by errant and reckless doctors.

28.             Keeping in view the decisions of the Apex Court in the cases discussed above, and the decision rendered by this state Commission in Complaint Case no. 4 of 2007 decided on 05/05/2017 involving the Regional Institute of Medical Sciences and 2 of its doctors,  we are of the considered view that the O.P. Nos.1, 2 & 3 did not charge any fees for their service rendered to the complainant’s wife while the complainant’s wife was at RIMS Hospital is not legally valid ground for escaping their liabilities for medical negligence within the purview of the Consumer Protection Act, 1986. The O.P. Nos. 4, 5 & 6 had charged fees at the time of Registration, Admission and Investigation like X-Rays, Blood & other fluid/ specimen examinations rendered by the hospital. In the result, we hold that the present complaint is maintainable under the Consumer Protection Act, 1986.

29.           The contention of the Complainant is that the wife of the complainant was admitted with 38 weeks pregnancy at RIMS on 04/07/2016. At the time of admission the Doctor on duty informed the complainant and his family that the patient was completely normal. At about 8.30 p.m. of 05/07/2016 the complainant and his family members were informed about the birth of a baby girl by normal delivery and the baby girl was handed over to the family members of the complainant. The deceased patient was profusely bleeding after the delivery and she was kept in the labour room for observation and started giving blood to her till 11.30 p.m. Thereafter, the deceased patient was referred to the operation theatre at around 11.40 p.m. as the condition of the victim got deteriorated. The complainant and his family members inquired about the condition of the victim to the doctors on duty who gave positive response. The exact condition of the victim was not informed by any doctors or staff, hence the complainant having full belief and confidence on the doctors hoped for the best.

30.            Very surprisingly at around 11.45 p.m., on 05/07/2016 at O.T. room, the doctor and nurse on duty searched for the complainant and asked him to sign a paper and also asked some family members to be witnesses for operation. Reluctantly, the complainant signed in the piece of paper and his younger brother Th. Suresh also signed as a witness. The query of the complainant about the contents of the said paper for which the signature was obtained was not properly explained to the complainant and his family. In the meantime, the nurse and doctor asked the complainant to get some blanket and hot water bag for the patient which was given immediately. After a long time to a great shock and surprise to the complainant and his family members at about 4 a.m. of 06/07/2016, the complainant was informed by the Senior Resident on duty that the deceased patient had expired.

31.    O.P No.1 as D.W. No.1 deposed that on 05.07.2016 during normal OPD round, the O.P. No.1 along with his unit head namely Prof. Dr. N.K. Singh and other colleagues examined the deceased patient and also perused her available medical records and history. They found the health condition of the deceased patient quite normal and as such after discussion, they have decided to induce the deceased patient (Th. Kheroda Devi) for normal delivery. Thus, at around 11.30 a.m. of 05.07.2016, O.P. No.1 inserted the cerviprime gel to the patient after putting her in the labour room so that she may deliver the child vaginally (normal delivery). After the ward round was over at about 12.30 p.m. of 05.07.2016, the O.P. No.1 was engaged in the operation theatre to operate two patients till 5 p.m. of 05.07.2016.

         O.P. no.1 as D.W. No.1 further deposed that at around 8 p.m. of 05.07.2016 when he reached RIMS, he first went to the Special Ward of RIMS before coming to the Labour Room for the night duty to check up the conditions of the patients who were operated by him in the afternoon. At around 8.30 p.m. of 05.07.2016, when O.P. No.1 reached the labour room, Smt. Th. Kheroda Devi had delivered a baby girl through normal vaginal delivery under the assistance of the team doctors of O.P. No.1 and even after delivery, her condition was also stable and quite normal. Thereafter, the O.P. No.1 was attending 7(seven) more patients in the labour room and did necessary counseling. O.P. No.1 also met mother of deceased patient during the period from 8.30 p.m. to 9.30 p.m. of 05.07.2016 in the labour room and gave one injection “Reglan” and another injection “Perinosm” for her daughter (Th. Kheroda Devi). There was no complaint/mention of excessive bleeding of the patient except the mild bleeding which a patient normally faces at the time of vaginal/normal delivery.

         Thereafter at around 9.30 p.m. of 05.07.2016, the O.P. no.1 left the labour room for Emergency O.T for attending two patients. At about 11 p.m. the O.P.No.1 was informed of the changing health condition of Smt. Th. Kheroda Devi. Immediately the patient was shifted to the operation theatre and the O.P. No.1 had started examination of the deceased patient in the operation theater with the assistance of the anesthesia team led by the O.P. No.3 and also under the supervision of his team head Professor H. Nabakumar Singh but they could not save the life of Smt. Th. Kheroda Devi and she was officially declared dead by 4.30 a.m. of 06.07.2016.

                  During evidence the complainant (P.W. No. 1) admitted that O.P. No. 1 had conducted operation to the patient at around 11.45 pm of 05/07/2016. Th. Suresh (P.W. No. 2) deposed that the deceased patient delivered a baby girl at around 8.26/ 8.30 pm of 05/07/2016 and there was no bleeding after delivery.

                  As per history sheet of the patient (Exhibit P/19, Page 26), from the time of delivery at around 8.30 pm till the post delivery check up at around 10 pm, no report of bleeding was recorded. But only after the check up time at 10.20 pm, the case of bleeding has been reported and only at around 11 pm of 05/07/2016, the case was reported to the O.P. No. 1 and at the relevant time the O.P. No.1 was in the operation theatre attending other patients and the deceased patient was shifted/ taken to the operation theatre from the labour room of RIMS Hospital and examination under the anaesthesia was started at around 11.45 pm of 05/07/2016 (Ref: Page Nos. 27, 29, 30, 31 and 32  of Exhibit P/19)

                  Shri Huidrom Shangba, P.W. No. 4 during evidence admitted that 05/07/2016  the O.P. No. 1  performed the necessary operation to the deceased patient Th. Kheroda  to save her life.

      The evidence of Dr. L. Trinity corroborated/supported by the evidence of other witnesses could not be shaken during cross examination.

32.             Summarizing the evidence and pleadings on record as discussed above, it is found that O. P. No. 1 came for duty at 8 pm on 05/07/2016, first took round of patient in the special ward, at 8.20 pm of 05/07/2016, he was informed by the P.Gs. about Mrs. Kheroda for her bleeding and that she was going to deliver. at 8.26 pm he was informed that a baby girl was delivered to Mrs. Kheroda. At the relevant time O.P. No. 1 was by the side of Mrs. Kheroda in the labour room during 8.35 to 8.40 pm. Thus O.P. No. 1 noticed/assessed Mrs. Kheroda just before, during and immediate post partum period Then O.P. No. 1 made a round of other patients in the labour room. After that he went to the operation theatre for 2 (two) Caesarean sections and another C.S. anticipated but delivered by Ventouse since O.P. No. 1 would be busy in  the operation theatre after Mrs. Kheroda gave birth a baby girl.

33.             In the case of Martin F D’Souza V Mohd Ishfaq reported in 9(2009) 3 SCC 1 and ii) in the Judgment & Order of the Hon'ble Supreme Court of India dated 30/11/2021 passed in Bombay Hospital & Medical Research Centre vs Asha Jaiswal & Ors, the Hon'ble court has held that the doctor cannot be held liable for medical negligence by applying the doctrine of res ipsa loquitur for the reason that a patient has not favourably responded to a treatment given by a doctor or a surgery has failed. There is a tendency to blame the doctor when a patient dies or suffers some mishap. This is an intolerant conduct of the family members to not accept the death in such cases. The increased cases of manhandling of medical professionals who worked day and night without their comfort has been very well seen in this pandemic.

                  In the above facts and circumstances, the O.P. No. 1 being a responsible doctor tried his best level to save the life of the deceased patient but failed to save her life due to her suffering from a rare disease detected only through Histopathology and Toxicology test done after her death and its  complications. There was no dereliction from duty and negligence on the part of the O.P. No. 1 in the course of diagnosis and treatment of the deceased patient. We further hold that it is not the case of the complainant that deceased patient was wrongly medicated or treated without correct diagnosis

34.             Dr. Yohen, O.P. No.2, as D.W. No.4 deposed that his duty period was from 8 am to 8.pm on 05/06/2016. the progress of labour of the victim was adequately normal as the cervical dilatation was found at 4 cm at 7 at 7.50 pm of 5/7/2016 and Meconium staining of liquor was also noted as early as 7 pm which was found no abnormality in the fetal heart rate or rhythm during labour and a healthy female child was delivered who cried immediately at birth was an example of no signs of fetal distress.

                  On the same day of 5/7/2016 at about 7.55 pm, the O.P. No.2 was managing another patient in High Dependancy Unit, situated adjacent to labour ward, who had no urine output following caecsarcan delivery complicated by post partum haemorrhage, in consultation with the unit Associate Professor Dr. R.K Praneshwari and corrective measures were being taken as per her advice. The OP No. 2 was informed by one post graduate trainee Dr. Dinesh Kumar Singh at about 8 pm that the victim (Th. Kheroda) had about 20 ml of bleeding, the OP No.2 immediately rushed to examine the victim but the victim was found to be at normal pulse rate & blood pressure, regular urine contractions and normal heart rate and no further bleeding. The O.P. No.2 asked Dr. Dinesh Singh to call and ask Dr. Trinity about the bleeding which was duly done in his presence till 8.00p.m of 5/7/2016 and at the relevant point of time. Dr. Trinity Meetei was already in the hospital premise. The said Dr. Trinity would be on duty after the O.P.No.2 completed his duty at 8.00 pm. O.P. No.2 then left the Hospital. No further bleeding was informed to the OP No.2 after 8.00 pm. Thus, the O.P. No. 2 had followed all the norms in the management of the victim's labour.

                  As per the post mortem report dated 25/07/2016 (Exhibit C/4)  the cause of death of patient Mrs. Th. Kheroda Devi death could be due to intrapartum hemorrhage i.e., during delivery and following normal vaginal delivery due to Cervical Arterio venous Malformation which was never detected in the patient Mrs. Th. Kheroda Devi throughout her ante natal investigations and medical consultations.

35.             The deceased patient was declared fit for normal delivery by Opposite Party No.1 (then a well renowned doctor who may be more than 10 years experience) and Professor Dr. Nabakishore Singh(Head of Unit I with more than 30 years of experience) after examining her medical records. Opposite Party No.1 then induced the patient Mrs. Th. Kheroda Devi for normal delivery by inserting Cerviprime at around 11.30 am of 05/07/2016. It is also highly pertinent to mention here that Professor Dr. Nabakishore Singh at 2.30 pm of 05/07/2016 once more monitored the patient Mrs. Th Kheroda Devi along with the PG Doctors on duty and her condition was found to be normal as is found in the Exhibit C/9 page 2 which is the examination in chief in the form of affidavit of Professor Dr. Nabakishore Singh and also in page No.1 & 2 of the cross examination dated 26/11/2018 by the Ld. Counsel for the complainant, the relevant portion of which is reproduced hereunder for reference:-

Cross examination by the learned counsel appearing for the Complainant.

 Q. Is it true that the Haemoglobin level of a pregnant woman about 8.4 gm % is low?

Ans. It is moderate.

At about 2.30 p.m. of 05.07.2016, I along with the Post Graduate Doctors had visited the patient Kheroda Devi for reassessment about her condition.

At the time of re-visit i.e. at the time about 2.30 p.m. of 05.07.2016, the condition of the patient Kheroda Devi was normal.

36.             In view of the evidence on record and discussion thereof, we are of the view that there was no negligence and no dereliction from duty on the part of O.P. No.2 in course of diagnosis and treatment of the deceased patient in as much as the O.P. No.2 did all that was possible to do his duty to the best of his ability.

      37.             The alleged non coverage by O.P. No. 3 namely Dr. K. Jina, Sr. Resident, Anaesthesiology department during the earlier part of anaesthetic cover for the EUA in the O.T. in respect of the treatment/operation of the deceased patient was due to the fact that she could not leave the ICU immediately as there were cases of emergency thereat and consequently she gave proper advice to her PGS on phone and advised to go ahead with the anesthesia. The O.P No.3 was very much available in the ICU and as such she told her junior doctors in the operation theatre that she would be coming after managing the patient in the ICU since she knew the competence of her team, she told them to go ahead with anesthesia. It would be well imagined that how one doctor would be humanly possible to be present at 2(two) work places at the same time. The O.P. No.3 did all that was possible to do her duty to the best of her ability. Thus, we are constrained to hold that there was no negligence and no dereliction from duty on the part of O.P. No.3 in course of treatment of the deceased patient

      38.             Now we are on the issue of consideration of question of deficiency in service on the part of O.P.Nos.4 to 6 in the matter of allotment of duties to the O.P.Nos.1 to 3 without considering doctor-patient ratio and for not keeping a working Defibrillator at the operation theatre thereby precious reasonable time was lost till a new functional Defibrillator was searched and go to the operation theatre.

                  Due to the nature of workload assigned to the O.P. No.1 by the O.P. Nos. 4 to 6 at different work places, the O.P. No.1 could not attend Smt. Kheroda Devi personally during the post-partum period from 9.30 p.m. to 11 p.m. of 05.07.2016 in the labour room physically. Consequently, Dr. L. Trinity, O.P.No.1 failed to examine the patient till 11.45 p.m. Timely remedial measures could be taken up for treatment of late Th. Kheroda Devi if the O.P. No.1.. Dr. Trinity or any other specialist doctors were made available by O.P. Nos. 4 to 6 round the clock in the labour room premises 24x7. Due to maladministration such measures were not implemented by the O.P. Nos. 4,5 & 6 at the relevant  time of treatment of Smt. Th. Kheroda Devi. Had the O.P. Nos. 4, 5 & 6 taken up the above stated measures the O.P. No. 1 could resort to timely remedial measures and the O.P. No. 1 could make early intervention before 11.45 pm on 05/07/2016 in respect of the deceased patient in the form of laparotomy and/or Hysterectomy to save the life of the patient which the  O.P. Nos. 4, 5 & 6 did not do so. The problem of underestimation of the seriousness of the patient and timely intervention thereof, lack of proper communication among the doctors including proper handing over of the patient (for Dr. N. Yohen, Dr. L. Trinity and PGs) and non availability of Dr. K. Jina, Sr. Resident in the earlier part of anaesthetic cover for the EUA in the O.T. etc. could all be addressed properly if the above stated measures were taken up by O.P. Nos. 4 to 6 at the relevant time of treatment of late Mrs. Th. Kheroda Devi. In the result, we are of the view that the non-implementation of the above stated measures by the O.P. Nos. 4, 5 & 6 at the relevant time of treatment of the patient would amount to negligence and deficiency in service on the part of O.P. Nos. 4, 5 and 6.

      39.             The Apex Court in V. Krishnakumar –vs- State of Tamil Nadu & Ors. (2015) 9 SCC 388 held that the state would be vicariously liable on account of negligence of its doctors and other employee. Para 34 of the SCC in V. Krishnakumar’ case (supra) reads as follows

                        “34.     It is settled law that the Hospital is vicariously liable for the acts of its doctors vide Savita Garg v. National Heart Institute, also followed in Balram Prasad case. Similarly in Achutrao Haribhau Khodwa v. State of  Maharashtra, this Court unequivocally held that the State would be vicariously liable for the damages which may become payable on account of negligence of its doctors or other employees. By the same measure, it is not possible to absolve Respondent 1, the State of Tamil Nadu, which established and administers such hospitals through its Department of Health, from its liability.

                        40.           In view of the evidence on record and also keeping in view the above decision of the Apex Court, we hold that the O.P. Nos. 4, 5 and 6 are vicariously liable for the acts of its doctors who are O.P. No.1, 2 and 3 in connection with the facts and circumstances leading to the death of Smt. Th. Kheroda Devi. Therefore, we hold that O.P. Nos. 4, 5 and 6 shall be liable to pay compensation for their negligence and deficiency in service towards the treatment of deceased patient.

Compensation

      41.             Now we are on the point of compensation to be awarded. a sum of Rs. 97,20,000/- (Rupees Ninety Seven lakhs twenty seven thousand) only and Rs. 1,00,000/- (Rupees One lakh) only have been claimed  on different counts.

                  The complainant has pleaded that his deceased wife was  34  years old at the time of her death, she was then serving as a teacher of Manipuri Meetei Mayek in the Camps English Academy, Khabam lamkhai and she could have served for another 27 (twenty seven) years if she survives. She was getting monthly salary of Rs. 6242/- (Rupees Six Thousand Two Hundred and forty Two) as the said school teacher in addition to her earning Rs. 25000/- (Twenty Five Thousand) per month for giving private tuition. The complainant could not prove on record that his deceased wife could earn Rs. 25000/- (Rupees Twenty Five Thousand) in addition to her monthly salary as the said school teacher. According to the complainant his deceased wife should have served for another 27 years if she did not meet untimely death. Thus, it would be justified to estimate loss of income of the complainant’s wife at Rs. 6242/- X12=74904X27=2022408 (Rupees Twenty Lakh Twenty Two Thousand Four Hundred and eight) only

                  The complainant has not shown any specific amount regarding medical expenses which he incurred during the treatment of his deceased wife at RIMS Hospital. He only filed and exhibited the money receipt dated 04/07/2016 (Exhibit P/22) issued by the RIMS authority. However, the expenses incurred in the medical treatment is approximately estimated at Rs.2000/- only.

42.             The Apex Court in State of Haryana & Anr. vs. Jasbir Kaur & Ors. (2003)7 SCC 484 held that there can be no golden rule applicable to all cases for measuring the value of human life or a limb. Measure of damages cannot be arrived at by precise mathematical calculations. Every method or mode adopted for assessing compensation has to be considered in the background of "just" compensation which is the pivotal consideration and requires judicious approach. The expression "just" denotes equitability, fairness, reasonableness and non-arbitrariness. These are two types of damages viz. Pecuniary Damages (Special damages) and Non-pecuniary Damages (General Damages) (ref.: Raj Kumar vs. Ajay Kumar & Ors. (2011)1 SCC 343). In the present case, what would be the "just" compensation in the light of the decision of the Apex Court in State of Haryana & Anr vs. Jasbir Kaur & Ors (2003)7 SCC 484, is the compensation which is equitable, fair, reasonable and non-arbitrary.

43.             The Apex Court in V. Krishnakumar vs. State of Tamil Nadu & Ors. (2015) 9 SCC 388 held that  "Quantification of compensation

19.       The principle of awarding compensation that can be safely relied on is restitution in integrum. This principle has been recognized as relied on in Malay Kumar Ganguly v. Sukumar Mukherjee ((2009) 9 SCC 221: (2009) 3 SCC (Civ)663: (2010) 2 SCC (Cril) 299) and in Balram Prasad case ((2014)1 SCC 384: (2014) 1 SCC (Civ) 327) in the following passage from the latter: (Malay Kumar Ganguly v. Sukumar Mukherjee ((2009) 9 SCC 221: (2009) 3 SCC (Civ) 663: (2010) 2 SCC (Cril) 299), SCC p. 282. para 170)

"170. Indisputably, grant of compensation involving an accident is within the realm of law of torts. It is based on the principle of restitution in integrum. The said principle provides that a person entitled to damages should, as nearly as possible, get that sum of money which would put him in the same position, as he would have been if he had not sustained that wrong. (See Livingston v. Raywards Coal Co. ((1880) LR 5 AC 25 (HL))"

An application of this principle is that the aggrieved person should get that sum of money, which would put him in the same position if he had not sustained the wrong. It must necessarily result in compensating the aggrieved person for the financial loss suffered due to the event, the pain and suffering undergone and the liability that he/she would have to incur due to the disability caused by the event."

44.       Keeping in view the above decisions of the Apex Court as to the amount of compensation, we are of the considered view that "just" compensation under different heads in the present complaint case are hereunder:-

Therefore, a total sum of Rs. 22,24,408/- (Rupees Twenty Two lakhs Twenty Four thousands Four hundred Eight) only is the compensation awarded in favour of the complainant. It can be rounded off to Rs. 22,24,000/- (Rupees Twenty Two lakhs Twenty Four thousands) only Opposite Party Nos.4, 5 and 6 are jointly and severally liable to pay the said compensation within a period of 3 (three) months from the date of passing this Judgment and Order. The said amount of compensation shall be deposited in the Registry of this Commission and Registry shall release the said amount of compensation to the complainant on being identified by a counsel known to this Commission. In case of failure to deposit, the said amount within the period indicated above there shall be interest @ of 9% per annum from the date of expiry of the period for depositing the amount mentioned above.

45.       The present Complaint case is allowed to the extent indicated above.

46.       The arguments in this case were heard on 08/02/2024 and the orders were reserved. Now, the order be communicated forthwith to the parties free of costs. Also the order be uploaded in the official website of the Commission for perusal of the parties.

The complaint could not be decided within the statutory period because of outbreak of Covid-19, Manipur Violence, non - availability of requisite benches and shortage of staff in the State Commission, for which the State Government has already been requested on several occasions but with no effect till date.

47.       File be consigned in the record room.