Dated this the 26^th  day of March 2013

 

Present : Smt.Seena H, President

Pradeesh,

S/o.Janardhanan,

Jellippara, Agali,

Mannarkkad Taluk,

Palakkad – 678 581                               -      Complainant

(By Adv.P.R.Jayakrishnan)

V/s

 

1.Dr.Mrs.Rajina P.T. M.B.B.S.DGO

(By Adv.V.K.Venugopalan)

 

2.Dr.Raveendran

(By Adv.V.K.Venugopalan) 

 

By Smt.SEENA.H, PRESIDENT

Facts of the case:

Complainant’s wife was under the medical treatment and management by 1^st opposite party under the 2^nd opposite party’s hospital during the last 3 months for her delivery. The various laboratory examinations and ultrasound examinations showed no abnormalities. Complainant’s wife was admitted for her delivery and has given birth to a baby boy on 25/5/2010 at 2.50 A.M. 1^st opposite party told the complainant that everything was normal, but the new born baby was seen partially paralysed due to the strong pull during labour. The right eye, hand and leg were not in a position to make action. The baby was paralysed due to the negligence from the part of the doctor while taking delivery. Though the complainant has given consent for caesarian operation, 1^st opposite party has not done that. 2^nd opposite party is vicariously liable for the negligent  act of the 1^st opposite party. As per the expert opinion complete recovery of the child is very remote.

For the treatment of the baby, complainant has incurred huge expense. Complainant has caused lawyer notice to both opposite parties, for which 1^st opposite party replied stating untrue facts. 2^nd opposite party has not replied at all.  Hence, the complaint. Complainant prays for an amount of Rs.10 lakh as compensation for the negligence and deficiency in service on the part of opposite parties.

1^st and 2^nd opposite parties entered appearance and filed version contending the following:

The patient was a primi gravid with expected date of delivery on 31/5/2010. The patient came up for antenatal consultation with the first opposite party on 23/4/2010 at her 34^th weeks of gestation. Her general condition and abdominal examination findings were within normal limits. The USG finding was normal except for low normal liquor. The patient reviewed on 7/5/2010 with complaints of vomiting. Per vaginal examination showed uneffaced cervix and closed os and the USG revealed normal foetus with weight 3kg. Foetal Heart Sound (FHS) was found good and there were no contractions. The patient was treated conservatively and asked to come for review on 24/5/2010 for further checkup.

On 24/5/2010 at 7.45 PM the patient came to the labour room with complaints of pain and on examination she was found to have onset early labour pain. Hence the patient was admitted to the second opposite party hospital and at about 8.15PM she had developed mild pain and it was informed to the bystanders. The first opposite party gave instructions for close observation of the condition and continuous foetal heart monitoring. The patient was getting gradual moderate contractions by about 12.30AM and she was shifted to the labour room. Foetal heart sound was normal and cervix was found 50% effaced and vertex at - 2 station. The patient went into spontaneous rupture of membrane at 1.20 AM and on examination foetal heart rate was normal and BP was 110/70 mmhg. Cervix was fully effaced and 2-4 cm dilated and liquor was clear and head was at 1 station. Plain fluid followed by oxytocin acceleration started.

The process of labour was progressing well and at 2.30AM the patient was getting good contractions and cervix fully effaced with 8cm dilated with clear liquor and vertex at 0 station with no caput or moulding. All the clinical findings were favourable for a normal vaginal delivery. When cervix fully dilated episiotomy was given and head delivered spontaneously. Following that there occurred an unexpected short delay in rotation of baby’s shoulder and it was clinically diagnosed as shoulder dystocia. Hence under all aseptic care and caution, the first opposite party resorted to MacRobert’s maneuver and with supra pubic pressure after extending episiotomy the baby was delivered. Placenta and membrane expelled entirely. Episiotomy sutured and the patient had developed mild atonicity of uterus and the same was treated with inj.prostodin and tab.Misoprost.

The baby cried immediately on delivery and the Apgar score was 9. On examining the baby, it was found to have weakness of the right upper limb. The first opposite party informed the complainant and other relatives of the patient about the occurrence of shoulder dystocia, its management and the detected weakness of the right upper limb of the baby. In view of shoulder dystocia and weakness of the right upper limb, the baby was referred to the pediatrician. The pediatrician and orthopedician examined the baby and diagnosed to have brachial plexus palsy. X-ray examination did not reveal any bony injury and the baby was found to have ptosis and hence referred to neurologist for further evaluation and management.

Shoulder dystocia is an unpredictable event and the same is not caused due to any act or omission on the part of the gynecologist who attend the delivery and in such cases the first step is MacRobert’s maneuver and the patient easily delivered with MacRobert’s maneuver with supra pubic pressure. The management of the delivery of the patient was in accordance with standard and medically accepted practice in strict regard to accepted medical protocol. The first opposite party had exercised all reasonable degree of skill and care in the treatment of the patient and there was no negligence or deficiency in service on her part and hence she is not liable to compensate the complainant.

MacRobert’s maneuver with supra pubic pressure is the medically accepted primary step and in the present case the baby delivered easily with the said procedure. Hence the allegation that baby was strongly pulled out and the right side of the baby was paralysed is falsely and purposely stated with ulterior motive. The averment that right eye, hand and leg were not in a position to make action due to the act of the doctor is also highly ill motivated and hence denied. The first opposite party is not aware of the modality of treatment of the baby at Moulana Hospital and hence the statement that the complainant has incurred huge expenses is thus denied.

The statement that the first opposite party could have taken the baby safely by Caesarean is made with lack of understanding about the facts of the case in the correct perspective. Caesarean operation was not indicated in the case of the complainant’s wife as her labour had been normally progressing without any signs of foetal distress. During second stage of labour also there was no complication till the delivery of baby’s head and thereafter slight difficulty in delivering shoulder was noticed and the same was diagnosed as shoulder dystocia. Doing caesarean section after delivery of the head is not at all easy and it carried maternal and foetal risk. It is tried only as a last resort when all other maneuvers fail.

The statement that the complainant had given consent for doing operation also is not relevant as there was no indication for doing caesarean operation either elective or emergency. The first opposite party had acted as per accepted medical practice in resorting to MacRobert’s maneuver which is the primary step in management of shoulder dystocia and there were well founded reasons for not resorting to caesarean section as a first step in the management of shoulder dystocia.

The brachial plexus palsy diagnosed to have caused to the complainant’s child was not caused due to any lack of care or caution on the part of the first opposite party. It is attributable to intra uterine causes where the baby’s shoulder is pressed against the pelvis of the mother which is not caused due to any act or omission on the part of the Gynaecologist.

2^nd opposite party also filed version in tune with the contention of 1^st opposite party.

The evidence adduced by the parties consists of the chief affidavits of the respective parties. Ext.A1 to Ext.A14 and Ext.B1 series marked. Complainant examined as PW1. 1^st Opposite party examined  as DW1. The doctor who treated the child examined as PW2. Other two gynecologists attached to the District Hospital examined as PW3 and PW4.

Issues for consideration are :

1.Whether there is any negligence and deficiency in service on the part of opposite parties 1 & 2

2. If so, what is the relief and cost complainant is entitled to ?

Heard both parties and has gone through the entire evidence on record.

The specific allegation leveled against the opposite parties is that the right side of the new born baby was partially paralysed due to the negligence from the part of the 1^st opposite party while taking delivery. The right eye, hand and leg were not in a position to make any action due to the effect of the strong pull made by the 1^st opposite party during delivery.

According to the opposite party, when the patient came with mild pain she was admitted and gave instructions for close observation. Foetal heart sound was normal. All the clinical findings were favourable for a normal delivery when Cervix fully  dilated episiotomy was given and head delivered spontaneously. Following that there occurred an unexpected short delay in rotation of the baby’s shoulder because of shoulder dystocia. 1^st opposite party resorted to Mac Robert’s maneuver  and the child was delivered. Mac Robert is the 1^st step to be resorted to is such case. It is as per the accepted medical procedure.  All these were duly informed to the complainant and other bystanders also.

In order to ascertain whether there is any deficiency in service on the part of the opposite parties, the following questions has to be answered first.

1.    Whether shoulder dystocia  can be predicted prior to delivery ?

2.    Whether resorting to MacRobert’s maneuver is the 1^st step in case of shoulder dystocia and whether it is the accepted medical practice.

According to opposite party shoulder dystocia is an unpredictable event. In the book by William Obstetrics, it is said that most cases of shoulder dystocia cannot be predicted or prevented because there are no accurate methods to identify which foetus will develop this complication. The deposition of PW4, the gynaecologist attached to the District hospital is as follows:

Shoulder Shoulder dystocia. bone structure  bone structures\ ]Ánbpw muscles relaxations PW3 doctor who has 24 years experience in the field has also deposed that “Doctor¡v  shoulder dystocia    So as per the authorities and as per the expert opinion, shoulder dystocia is unpredictable.

Now regarding the next step for further management of shoulder dystocia it is stated in  Williams Obstetrics

1.Moderate supra pubic pressure is applied by an assistant while downward traction is applied to the fetal head.

2. Mc Roberts  maneuver : The maneuver consists of removing the legs from the stirrups and sharply flexing them upon the abdomen.

DW1 has deposed that she resorted to Mc Robert’s maneuver with supra pubic pressure after extending episiotomy and the baby was delivered. PW4 while cross examination has also stated that  instruments . McRoberts method failure crokscrew method

So we find that the 1^st opposite party doctor has adopted the accepted medical practice.

Further complainant has stated that the child has problem with the right eye, hand and leg. Ext.B1 case sheet shows weakness of right upper limb noted. Ext.A4 the certificate issued by Dr.Saji who have treated the child also shows ERBS paralysis right upper limb. No other problems noted. PW2 has also deposed that

The evidence on record clearly shows that paralysis of right upper limb is due to shoulder dystocia which is unpredictable as per medical  experts. No evidence to show that strong pull has resulted in the paralysis.

In view of the above discussion, we find that complainant miserably failed to prove negligence on the part of the opposite parties. Hence, complaint dismissed.

Pronounced in the open court on this the  26^th  day of March  2013.

 Sd/-

Seena H

President

Preetha G Nair

Member

 Sd/-

Bhanumathi.A.K.

Member

 

Ext.A1 – Lawyer notice to opposite party dated 15/6/2010

Ext.A2 – Postal receipt

Ext.A3 – Lawyer notice sent by 1^st opposite party dated 12/7/2010

Ext.A4 – Medical Certificate from Dr.Saji K Subair

Ext.A5 – Acknowledgment card signed by 2^nd opposite party

Ext.A6 – Birth report from 2^nd opposite party’s hospital

Ext.A7 – Prescription issued by 1^st opposite party

Ext.A8 – Receipt given by 2^nd opposite party’s hospital

Ext.A9 – OP report dated 23/4/2010

Ext.A10 series –Medical bills (14 nos)

Ext.A11 series – Scan reports (5 nos.)

Ext.A12series  –OP cards (13 nos)

Ext.A13 – Certificate received from Moulana Hospital dtd.11/4/12

Ext.A14 – Certificate received from Moulana Hospital dtd.11/4/2012

 

Ext.B1 – Case Sheet (Original)

 

PW1 –Pratheesh T.G

PW2 –Dr.Saji K Subair

PW3 – Dr.C.K.Lathika

PW4 –Dr.Sindhu.B

 

DW1 –  Dr.Rajina.P.T

 

No cost allowed.