3

respondent’s hospital and also for treatment at Tirupati. Further the complainant

alleged that even now she is not able to do her household works due to weakness.

The Doctor of Mother Hospital advised the complainant to take rest for a period of 6

months. After operation at mother hospital, the husband of the complainant

approached the respondent and asked h e r for explanation for her negligent

treatment. But she never gave proper reply and asked him to get out. The

complainant issued legal notice to the respondent claiming compensation from the

respondent and the respondent gave reply notice with false allegations. The

complainant alleged deficiency of service and negligence on the part of the

respondent. Hence, the complaint.

4. The counter filed by the respondent stating that the complainant is put

to very strict proof of all the allegations admitted that it is true that the complainant

was admitted in her hospital for 2

visit t h e hospital for ante-natal checkup. During the first pregnancy also the

complainant got admitted in the hospital and after successful caesarian operation

made by the respondent doctor the complainant was blessed with a healthy child. At

the time of first delivery the respondent doctor clearly advised the complainant to

maintain minimum three years of gap for 2

to do so and got pregnancy within 14 months and she used to attend the hospital

irregularly for periodical checkup during the 2

weeks and after scanning, blood group test, percentage of HB, clotting time etc., the

complainant was advised for caesarian operation. The respondent further stated that

it is correct choice of treatment for a patient who had previous caesarian section,

with scar tenderness when she came to the hospital for delivery. To prevent scar

dehiscence which is risky both to mother and fetus she conducted caesarian section

and tubectomy on 15-7-2008. The complainant was in admission under the care of

4

the respondent for one week till the sutures were removed and was discharged on

21-7-2008 with details of operation were mentioned in the discharge summary. The

caesarian operation was conducted after getting consent in writing from the husband

of the complainant. After discharge of 7 days i.e. on 28-7-2008 the complainant

approached the respondent for regular checkup and there is no problem. But on

30-7-2008 when the complainant visited the hospital with bleeding trouble

immediately the respondent provided best treatment of arranging blood transfusion

and prescribed antibiotics and other medicines for contraction of uterus to stop

bleeding. After one week i.e. on 8-8-2008 the complainant again approached the

respondent with a complaint of bleeding. The respondent made checkup. The

complainant requested the respondent to refer to her some other hospital for 2

opinion so she gave a referral to Mother Hospital, Tirupati. Again after 4 days the

complainant approached the respondent and informed that her condition is good

after taking treatment in Mother Hospital, Tirupati. The respondent further stated

that if the sutures in uterus were not properly done, the patient would have blood

immediately in the first few hours after the surgery. If there was a bladder injury, the

patient would have had Haematuria but it was not happened in the present case.

The respondent denied that the complainant has not visited the hospital after 2 days

of discharge with severe bleeding problem. Generally bleeding during the period after

caesarian section is due to sub involution of uterine blood vessel and some times due

to infection.

5. On 25

the respondent did D & C for removal of retained products. After seeing the legal

notice issued by the complainant the respondent came to know that Laparatomy was

conducted to her on 10-9-2008. The respondent denied that it is baseless allegation

that she gave wrong treatment and treated her carelessly in a rash and negligent

5

manner. The respondent further stated that regarding points noted by Dr. Padmaja,

she put the diagnosis as rupture uterine scar – post caesarian operation which itself

is not correct. The rupture uterine occurs only at the time of full term pregnancy or

at the time of labour because of weakness of previous scar. As per discharge

summary, the uterus size is bulky. Bulky sized uterus means involution of uterus

has occurred and the involution of uterus itself is almost complete, the suture line

also shrinks to a very small size. After two months of caesarian section with this

pregnancy sized uterus, rupture of uterine scar does not arise. At the time of

admission at Tirupati the complainant’s pulse rate is normal and B.P. is also normal,

it means her general condition was good at the time of admission in Mother Hospital.

In post caesarian case during D & C, there might be a chance of perforation to

uterine scar due to weak, tender and thin caesarian scar.

2

If the sutures would be opened, immediately there should be massive

bleeding from the uterine incision in to the abdominal cavity or uterine cavity. There

is no such bleeding history from the patient upto two weeks after surgery. In case

bleeding occurred externally, i.e. outside uterus through opened sutures, there

should be Haemoperitoneum (blood collection in the abdominal cavity), resulting in

peritonitis and paralytic ileus to the patient in which patient will have the symptoms

of high fever and severe abdominal pain. There were no observations of such signs

Dr. Padmajas discharge summary also.

3

4

Serosal Tear occurs during separation of bladder in caesarian section in

Hysterictomies also. But serosal tear heals within hours without any complications.

The respondent further stated that the complainant has paid only Rs. 5,000/-

towards surgery and hospital and Rs. 1200/- towards anesthetist and Rs. 2,500/-

6

towards medicines. But not huge amounts as stated by the complainant. There is

no any negligence on the part of the respondent in conducting the caesarian

operation to the complainant. They are not liable to pay any compensation to the

complainant and there is no any deficiency of service on the part of the respondent.

6. On behalf of the complainant Ex. A1 to A9 were marked and no

documents were filed and marked on the side of the respondent.

7. On the basis of the above pleadings the following points are settled for

determination.

i. Whether the complainant is entitled to receive the amount towards

compensation from the respondent doctor?

ii. Whether there is any negligence and deficiency of service on the

part of the respondent?

iii. To what relief?

8. Point Nos. 1 & 2 Heard both sides and perused the records available

with the forum and forum made the following order. The complainant is the house

wife, who approached the respondent doctor for treatment for 2

the admission the complainant use to attend the hospital of the respondent i.e.

Bhavana Nursing Home for monthly checkup of her pregnancy. On admission the

respondent doctor stated that there is no possibility for normal delivery and she

requires caesarian operation. On 15-7-2008 the respondent doctor conducted

caesarian operation to the complainant and removed the child from womb of the

complainant. The complainant was discharged on 21-7-2008. The complainant

stated that after two days of discharge from hospital she again attended the

respondent hospital with a complaint of severe bleeding. The respondent doctor gave

some normal treatment which was continued for 15 days but no relief to the

complainant. Again she visited the respondent hospital with same problem of severe

bleeding. The respondent doctor conducted DNC for control of bleeding. The

7

complainant did not get any relief with D&C also. Likewise she suffered with severe

bleeding for a period of 2 ½ months. So the complainant and her husband requested

the respondent doctor to refer them for expert treatment. The respondent referred

them to Tirupati and the complainant was admitted in mother hospital on 10-9-2008.

At the time of admission in the said hospital the complainant’s health condition was

serious and she was shifted to Operation Theater immediately and the doctor at

Mother Hospital conducted operation to control the bleeding. While conducting the

said operation the doctor of Mother Hospital found number of irregularities

committed at the time of caesarian operation conducted by the respondent doctor.

The observations noted in the discharge summary as 1) Sutures on uterus were

opened bladder was adherent to the suture line. 2) During dissection bladder serosal

tear present sutured with 2-0 chromic catgent. 3) Both tubes and ovares normal and

4) Rupture uterine scar. The doctor of the Mother hospital clearly explained the

complainant that the caesarian operation was conducted in a negligent and careless

manner because of that she suffered with severe bleeding etc.,

9. After Laparatomy the doctor advised the complainant to take rest for a

period of six months. After treatment at Mother Hospital the complainant returned

to Rajampet and her husband approached the respondent doctor and asked for

explanation for negligent treatment. The respondent doctor gave evasive reply. The

complainant issued legal notice through her advocate for claiming compensation for

her negligent act and deficiency of service. The respondent gave reply notice with

false allegations and she never explained anything about nature of operation

conducted by her. The complainant alleged negligence and deficiency of service on

the part of the respondent.

8

10. The respondent filed counter and denied the allegations made by the

complainant except that those are specifically admitted as it is true that she was

admitted in the hospital for 2

for ante-natal checkup. During his pregnancy also the complainant got admitted in

the hospital of the respondent and after successful caesarian operation made by her

the complainant was blessed with a healthy baby. At the time of first delivery the

respondent clearly advised the complainant to maintain minimum three years of gap

for 2

14 months and she was not attending the hospital regularly for periodical checkup

during her 2

tests she was advised for caesarian operation. On 15-7-2008 caesarian operation

was conducted to the complainant along with tubectomy and she was discharged

from the hospital on 21-7-2008. She was hale and healthy at the time of discharge

and after completion of 7 days in a routine manner she approached the respondent

for regular checkup and there was no problem at that time. Again after 2 days i.e.

30-7-2008 the complainant visited the hospital with bleeding and the respondent

provided treatment by arranging blood transfusion to the complainant and prescribed

same antibiotics. Again after one week i.e. 8-8-2008 the complainant approached the

respondent with some complaint of bleeding. Again the respondent started treatment

but out of anxiety on 9-8-2008 the complainant insisted the respondent to refer her

to some other hospital for 2

Senior Gynecologist along with history of case. The respondent denied that the

complainant did not visited the respondent hospital after 2 days of discharge with

severe bleeding. She stated that after caesarian operation bleeding would be there for

so many days. Due to infection also there may be bleeding. On 25

i.e. 8-8-2008 she conducted DNC also for removal of retained products. In their

9

counter the respondent answered the points noted by the doctor at Mother Hospital,

Tirupati.

11. The complainant was examined as PW1 on 8-4-2009. In Chief

Examination the PW1 was asked about exhibits which were submitted by her. In

cross examination by the respondent the PW1 stated that she got two deliveries. The

first delivery was three years back and the said operation was held at respondent’s

hospital only. For the first delivery also the respondent conducted caesarian

operation and was blessed with healthy baby. The PW1 denied that the respondent

did not advised her to maintain 3 years gap for 2

after one year six months, she use to attend the hospital at Koduru upto 5 months of

Pregnancy and after that she visited the respondent every month regularly. She

denied that she is not irregular in attending the hospital. She stated that she has

submitted Ex. A3 which reveals the attendance to the respondent’s hospital. After

completion of 9 months pregnancy they conducted all medical tests, that the

respondent conducted caesarian operation and her husband gave consent to the

caesarian operation. The witness stated that she has visited the respondent’s

hospital after 12 days and the respondent issued some antibiotics and arranged

blood transfusion. She stayed in the hospital for two days. Again after 7 days she

approached the respondent with severe bleeding and she conducted D&C and also

blood transfusion and prescribed some medicines. At that time also she stayed in

the hospital for two more days. On 10-9-2008 she visited mother hospital at Tirupati

and she entered into the hospital by walk and at that time her blood pressure was

normal. The witness denied that the respondent doctor treated her with utmost care.

She stated that she has not taken treatment for 2 ½ months in respondent’s hospital.

Witness stated that she has not filed the present case to blackmail the respondent

doctor for unlawful gain. She stated that she cannot say that it is normal in every

10

caesarian operation regarding adherence of bladder as noted by the Tirupati doctor.

She denied that Ex. A8 were not created for present case.

12. The complainant’s husband was examined as PW2. On examination he

stated that he is doing water selling business with partnership along with one friend.

The PW2 denied that the respondent has not issued any detailed report of treatment

to PW1. The PW2 denied that without adequate knowledge of medicine I deposed in

my chief examination regarding treatment conducted by the respondent doctor. He

stated that he has incurred an amount of Rs. 1,20,000/- towards treatment and he

borrowed amounts from his relatives. Ex. A1 was Xerox copy of hospital certificate

with regard to delivery issued by the respondent. Ex. A2 is the Obstetric report

(clinical history) in the name of the petitioner issued by the respondent. Ex. A3 is the

antenatal record issued by the respondent. Ex. A4 is the discharge card issued by

the respondent. Ex. A5 is the discharge summary issued by the Mother Hospital,

Tirupati. Ex. A6 is the office copy of notice issued by the complainant to the

respondent. Dt. 4-10-2008 with postal receipt and acknowledgement. Ex. A7 is the

reply notice received by the complainant from the respondent. Ex. A8 is the bunch of

medical bills (24 numbers) for Rs. 27,508/-. Ex. A9 is the paper cutting.

13. The counsel for the respondent argued that there is no any deficiency of

service or negligence on the part of the respondent doctor and the bleeding problem

was common in caesarian operation. To prevent the bleeding respondent doctor

conducted DNC also but out of anxiety the complainant and her husband visited

Tirupati. The complainant counsel filed paper cutting of Ex. A9 wherein the same

respondent doctor hospital nurses conducted delivery to the patient and the patient

died after delivery. The husband of the patient stated the above said fact.

11

14. Neither the complainant’s counsel nor the respondent counsel examined

any expert doctor for evidence. The case was posted for orders on 28-5-2009. At this

stage the Hon’ble Forum summoned the doctor who gave treatment doctor at Tirupati

by suimotto reopening the C.C. According to recent Supreme Court Judgement on

admission of medical negligence case in Consumer Fora their lordships gave

Judgement in “Martin F Dissouja Vs. Mohammed Ishak reported” in I 2009 CPJ

32 (SC) in an appeal against the judgment of the National Commission dt. 22-3-

2002. The Supreme Court allowed the appeal and set aside the order of the

National Commission observing that the Courts and Consumer Fora are not

experts in medical science and medicines substituted their own views as that

all specialists. For expert evidence in the present case the Hon’ble Forum

summoned Dr. Padmaja, who gave treatment to the complainant at Tirupati.

15. On 8-6-2009 witness recalled for chief examination. She was examined

as PW3. She stated that PW1 visited her hospital with severe bleeding pervagina.

PW1 told that bleeding was continuous since 2 months on and off. She exaplained

that in Ex. A5 she mentioned that the patient presented with severe bleeding,

pervagina DNC admitted due to severe bleeding planned for laproctomy. The word

adherence means abnormal union of two parts. The witness denied that the PW1

asked her about caesarian operation conducted by the respondent, and she never

answered that there are so many irregularities committed by Dr. Kameswaramma i.e.

respondent doctor.

At the stage:- The advocate for the complainant requested the Hon’ble

forum to treat the witness as Hostile, a n d permit to cross examination, and

permission granted. The witness stated that she never stated that due to

irregularities committed by Dr. Kameswaramma while conducting caesarian

operation the severe bleeding was occurred. She denied that in discharge summary

12

the finding Nos. 1 & 2 are with regard to previous doctor who conducted caesarian

operation on PW1. She denied that after receiving summons from the Hon’ble Forum

the respondent doctor approached her to help in this matter. The witnesses also

denied that Dr. Kameswaramma and she belongs to same community. i.e. doctors

community she is deposing falsehood to help the respondent doctor. On cross

examination the witnesses stated that PW1 visited her hospital and she came into the

hospital premises by walk. The word history mentioned in Ex. A5 means opinion of

PW1 only. While conducting operation’s she noted the observations as per operative

findings. She stated that it is very common in 99% caesarian cases bladder will be

adherent and due to malnutrition and also due to infection there will be reasons for

opening of sutches after 48 hours of surgery. The witness accepted that her findings

in Ex. A5 were noted after 2 months of caesarian operation of PW1. She denied that

opening of suitches after lapse of 48 hours from the time of caesarian operation not

with regard to sucher in technic but in the instant case I observed after completion of

two months gap. The witness stated that due to individual healing capacity of

uterus there will be possibility of opening of suichers and it differs from each and

everybody. She stated that she has not observed any bleeding in uterus at the time

of pre-operative findings. But she found small blood clots in the uterus. The

witness denied that she has received huge amount from PW1. The witness stated

that she has not observed any negligence in giving treatment to the complainant by

the respondent doctor. At this stage the witness was recalled for further chief

examination by the Hon’ble Forum and Hon’ble Forum imposed some questions.

Q. 1) What is the necessity in conducting DNC after cesarean?

Ans. If the patient does not response with the medical treatment DNC is the option

to stop the bleeding.

Q 2) How many days after DNC the complainant approached you?

Ans. After 20 days.

13

Q 3) After DNC you expect immediate relief?

Ans. After DNC we expect relief from bleeding within 24 to 48 hours if there are

no reasons.

Q 4) What are the reasons for appearing blood clots in the uterus after 2 months?

Ans. Could be due to endometritis.

16. By perusing the records available with the forum and the arguments

heard by both counsels, and the deposition given by the treating Dr. Padmaja it is

clear that the respond;ent doctor has given treatment to the complainant in a

negligent manner. While putting the questions by the Hon’ble Forum the expert

doctor answered that the DNC was conducted to any persons, and what was the

expected time for controlling the bleedings? She answered that it will take 24 hours

to 48 hours. But in the present case the respondent doctor conducted DNC to the

complainant to control the bleeding but no relief and the complainant suffered for 20

days and she approached the Mother Hospital doctor for remedy. The doctor

concuted laproctomy to the complainant and she got relief from heavy bleeding

problem. After delivery the complainant suffered with heavy bleeding for 2 ½

months. At the first instance she approached the respondent doctor with a severe

bleeding problem she prescribed some antibiotics. But there is no relief from the said

problem to the complainant. Against she visited the respondent doctor and she

conducted DNC arranged blood transfusion and prescribed some medicines. But no

relief to the complainant. Here we can see the negligent act of the respondent doctor,

on deposition the expert doctor opined after DNC one has to get relief within 24 to 48

hours. But why the complainant has suffered for so many days?. On examination

the expert doctor stated that she has observed some blood clots in uterus even after

delivery of 2 months. She answered could be due to endomctrits. The expert doctor

also stated that the bleeding may not be stopped even after 2 months also may be

14

some plasanta pieces were retained in the uterus. In normal delivery one can expect

some pieces of plazanta in uterus but not in case of caesarian because in caesarian

operation the doctor is opening the abdomin and they are removing the child from

mother’s womb directly. In such case no one can expect plazanta pieces in the

uterus. In any case the pieces were retained in uterus it shows direct negligence and

deficiency of service on the part of the respondent doctor, who conducted the

caesarian operation. By perusing Ex. A9 i.e. paper cutting it shows the attitude of

the respondent doctor in giving treatment to the patient, who visites her hospital.

The Forum has came to the conclusion that the respondent doctor has conducted

caesarian operation in a negligent manner which caused much pain and mental

agony to the complainant. For which the respondent doctor is liable to pay

compensation to the complainant.

17. Point No. 3 In the result, the complaint is allowed, directing the

respondent to pay Rs. 1,00,000/- (Rupees one lakh only) towards expenditure

incurred by the complainant, to pay Rs. 20,000/- (Rupees Twenty Thousand Only)

towards pain and suffering mental agony, to pay Rs. 5,000/- (Rupees Five Thousand

only) towards deficiency of service and Rs. 300/- (Rupees three hundred only)

towards costs, totaling Rs. 1,25,300/- (Rupees one lakh twenty five thousand three

hundred only) payable within 45 days from the date of receipt of this order. The rest

of the claim is dismissed.

Dictated to the Stenographer, transcribed by him, corrected and pronounced

by us in the open forum, this the 12

MEMBER MEMBER PRESIDENT

15

APPENDIX OF EVIDENCE

Witnesses examined.

For Complainant :

PW1 Shaik Shabana, dt. 8-4-2009.

PW2 Shaik Abdul Khadar, dt. 8-4-2009.

PW3 Dr. M. Padmaja, dt. 8-6-2009.

For Respondent : NIL

Exhibits marked for Complainant : -

Ex. A1 X/c of Delivery certificate issued by the respondent, dt. 1-7-2006.

Ex. A2 Obstetric report, dt. 29-4-2009 issued by the respondent.

Ex. A3 Antenatal record issued by the respondent.

Ex. A4 Discharge card issued by the respondent.

Ex. A5 X/c of discharge summary issued by the Mother Hospital, Tirupati.

Ex. A6 Copy of Legal notice issued by the complainant’s advocate to the

respondent, dt. 4-10-2008

Ex. A7 Reply notice from respondent’s advocate to complainant’s advocate

dt. 15-10-2008

Ex. A8 Bunch of medical bills (24 numbers)

Ex. A9 Paper cutting.

Exhibits marked for Respondents: -

MEMBER MEMBER PRESIDENT

Copy to :-

1) Sri M. Sudhakar Naidu, Advocate,

2) Sri T.V.S.S. Murthy, Advocate.

1) Copy was made ready on :

2) Copy was dispatched on :

3) Copy of delivered to parties :