IN THE DISTRICT CONSUMERS’ DISPUTES REDRESSAL FORUM AT MYSORE<br /> <br /> PRESENT: 1. Shri.D.Krishnappa<br /> B.A., L.L.B - President <br /> <br /> 2. Shri. Shivakumar.J.<br /> B.A., L.L.B., - Member<br /> CC 308/07 DATED 25-09-2008<br /> ORDER<br /> <br /> Complainant Smt.Madhavi, W/o G.V.Ravikumar, R/at D.No.10, Om Shakti Road, Shakti Nagar, Kalyanagiri, Mysore-570019.<br /> (By Sri.N.Sathish Kumar Aradya, Advocate)<br /> Vs. <br /> Opposite Parties 1. Administrative Officer, JSS Hospital, Ramanuja Road, Mysore.<br /> 2. Dr.Roopa Prakash, Obstetrician.<br /> 3. Dr.Subhash Chandra, Physician.<br /> 4. Dr.Jayaraj, Pulmunologist<br /> 5. Dr.Manjunatha Shetty, Nephrologist.<br /> 6. Dr.M.Shivakumar, Surgeon,O.P 2 to 6 are working in the 1st O.P. Hospital.<br /> 7. Administrative Officer, Victoria Hospital, Bangalore.<br /> 8. Administrative Officer / Director, Institute of Nephro-urology, Victoria Hospital Campus, Bangalore(7th and 8th O.P.s are DELETED)<br /> (By Sri.R.R Advocate for O.P.s 1 to 6)<br /> Nature of complaint : Deficiency in service<br /> Date of filing of complaint : 28.11.2007<br /> Date of appearance of O.P. : 03.01.2008<br /> Date of order : 25.09.2008<br /> Duration of Proceeding : 8 MONTHS 22 DAYS<br /> <br /> <br /> PRESIDENT <br /> <br /> <br /> MEMBER<br /> <br /> <br /> Sri.D.Krishnappa,<br /> President<br /> <br /> 1. This is a complaint presented by the complainant against the Opposite parties under section 12 of the Consumer Protection Act, 1986 alleging that she on 02.05.2007 got herself admitted to first Opposite party hospital for safe delivery with an obstetric history of primigravida; last menstrual period was on 23.07.2006 and expected date of delivery on 30.04.2007. She went in to labour spontaneously on 03.05.2007 at 5.30 am and delivered a live normal male baby. That on 05.05.2007 she developed fever with chills, mild abdominal distension and chest pain. Then opinion of third Opposite party was taken who suspected probabilities of Myocarditis. Then she was shifted to ICCU for observation and for further management. For abdominal distension opinion of sixth Opposite party was also taken on the same day who suspected Paralytic ileus. Then she was managed conservatively by prescribing certain medicines and catheterization was started to rule out the Myocarditis and Paralytic ileus necessary investigations were carried out, then erect abdomen x-ray showed ground glass appearance, urine routine showed plenty of pus cells. Then on 06.05.2007 opinion of sixth Opposite party was taken and she was managed by that Opposite parties. On 07.05.2007 she was shifted to RICU and then opinion of fourth Opposite party was taken who diagnosed as Acute Respiratory Distress Syndrome. Then the Opposite parties carried out investigations as per the third and fifth Opposite parties. On 08.05.2007 urinary output was found satisfactory. Her condition was found stable and improving. Existence of ascitis and small amount of free fluid in abdomen and pelvis was noticed. On 09.05.2007 abdominal distension was reduced, Ryle’s tube was removed, she was advised oral fluids. On 10.05.2007 she had abdominal distension and absence of bowel sounds. On 11.05.2007 she had again fever, abdominal distension with bowel sounds. Investigations as per the advise of third and fifth Opposite parties were carried out. Ascitis fluid was removed and sent to Cytology. In the report of Cytology cell count was noted as 1900 and it was increased to 4000. On 13.05.2007 surprisingly Montoeux test was carried out, it was found negative. On 14.05.2007 CT Thorox and pelvis was advised. The report revealed moderate pleural effusion with partial collapse of left lung, small amount of fluid in endometrial cavity was noted. On 16.05.2007 chest x-ray shown decreased effusion. On 17.05.2007 inter costal draining and ascitic tap reduced, she was improving. On 18.05.2007 repeat chest x-ray was advised by the fourth Opposite party, which shown inter costal draining in line with small pneumothorox. On 20.05.2007 ascitis drain was removed as it was minimized to 45 ml. On 21.05.2007 she felt better and was advised to have semi solid diet. Pleural fluid drain was nil. Repeat chest x-ray showed left side lower zone haziness with ICD, collapsed lung with pneumothorox. On 22.05.2007 she was improving. Urinary output was found satisfactory. On 23.05.2007 repeat ultra sonography shown minimal collection in the pleural and peritoneal cavity. On 25.05.2007 pleural fluid drain found nil and she was improving urine out put was found satisfactory. Catheter was removed as advised by the sixth Opposite party. On 26.05.2007 she had abdominal pain with a history of frequent small volume of urine. Mild abdominal distension was present. Then on the advise of the sixth Opposite party catheter was inserted and she was improving. On 27.05.2007 shifted to emergency ward from RICU. On 28.05.2007 on the advise of the Urology Department, catheterization was continued for 15 days as she was retaining urine after catheter was removed. On 30.05.2007 she was improving. The Opposite parties have therefore failed to know or diagnose the cause of fever with chills, mild abdominal distension, chest pain and evaluation of urine and creatinine and they started managing her at their whims and fancies. The Opposite parties diagnosed her in various problems, that her father was working as a ward boy in K.R.Hospital, Mysore who enquired about her health conditions with various doctors of that hospital with regard to her problems and that as per the minimum knowledge acquired by her father, he evaluated her problems by himself, which tallied with opinion he took from the doctors of K.R.Hospital, therefore he immediately shifted her to the hospital of seventh Opposite party that is Victoria Hospital for 2nd opinion and she was admitted to that hospital on 01.06.2007. On 05.06.2007 ultra sonography B mode real time gray scale was done, which revealed discontinuity noted in the postero lateral wall of bladder measuring 2.5 cms with mucosal irregularity and floating debries, with loculated collection in the pelvis with minimal ascitis. That to confirm bladder rupture CT scanning was done at Boring Hospital and got the report on 07.06.2007, then she was referred to the eight Opposite party for further management. Then on 09.06.2007 under supervision of Dr.Rathkal Laprotomy was done under general anaeshtesia and closure of bladder rupture was done and finally she was discharged on 10.08.2007 after lengthy treatment for 2 months 10 days. Therefore contended that the Opposite parties 1 to 6 were negligent in treating her like a doctors of ordinary prudence, indulged in unwarranted tests, as a result she spent Rs.2,00,000/- for treatment in the first Opposite party hospital and apart from spending Rs.1,50,000/- spent for treatment in the seventh and eight Opposite parties hospital. The complainant has therefore alleged that Opposite parties 1 to 6 while treating in the hospital of first Opposite party caused rupture to her urine bladder, which has resulted in complications she had faced. Therefore, she suffered expenditure of Rs.3,50,000/- including other expenditure amounting to Rs.6,00,000/- and thus attributing deficiency in the service of the Opposite parties has prayed for awarding compensation of Rs.6,00,000/- against the Opposite parties.<br /> 2. Considering the grievance of the complainant, this Forum had only ordered notice to Opposite parties 1 to 6 and then seventh and eight Opposite parties are ordered to be deleted as they were not necessary parties.<br /> 3. Opposite parties 1 to 6 have appeared through their advocate and filed a joint version. Opposite parties 1 to 6 in their version have contended that the complaint is not maintainable and is to be dismissed. They have admitted the contents of para No. 2 to 7 as true and correct and have stated that Montoux test was done on the complainant in a routine manner as the condition of the complainant warranted to rule out Tuberculosis. They have also admitted the contents of para No.13 to 15 and 17 to 19 as correct. They have further stated that the complainant approached the first Opposite party hospital on 02.05.2007, she was admitted with history of 9 months pregnancy and was subjected to clinical examination as she had crossed EDD, was admitted to their hospital and went to into spontaneous labour on 03.05.2007 and delivered a live male baby. That on 05.05.2007 at 8.00 pm the complainant complained of fever with chills, mild abdominal distension and chest pain. She was referred to third Opposite party who is a Specialist Physician for opinion, who opined as Myocarditis. She was shifted to ICCU for observation and further management. For abdominal distension she was referred to the sixth Opposite party who is a qualified surgeon, who suspected paralytic ileus and the complainant was managed conservatively. That the Opposite parties 2 to 6 based on their experience and skills managed the complainant advised investigations required to the conditions of the complainant. That test report revealed urine routine with plenty of pus cells and erect x-ray abdomen disclosed ground glass appearance. Then the complainant was referred to the fifth Opposite party who is qualified person with general medicine and also a Nephrologist who after examination opined that the complainant was undergoing acute renal failure, then the complainant was managed with necessary tests under medicines. That the conditions of the complainant was monitored round the clock by them. Then they shifted the complainant to RICU and opinion of pulmonologist was also taken by administering necessary medicines as per the opinion of the concerned specialists. Then on 08.05.2007 the condition of the complainant was found satisfactory. On 09.05.2007 Ryle’s tube was removed and was advised oral fluids. Then on 11.05.2007 patient developed fever, higher B.P., distension with bowel sound and investigations were done as per the advise of Nephrologist, Pulmonologist and Physician and tests were done accordingly. Then on 15.05.2007 CT Thorox, abdomen and pelvis shown moderate left pleural effusion with partial collapse of left lung, mild right pleural effusion, moderate ascitis, bulky uterus involuting small amount of fluid in endometrial cavity. Then advise of Pulmonologist was taken was treated. Then the complainant was improving in her condition, periodically tests as per the advise of Opposite parties 2 to 6 were done and by 21.05.2007, the complainant was feeling better was advised to have semi solid diet. On 22.05.2007 the complainant was improving, urinary output was satisfactory and the treatment was continued as per the specialist. They also found urine output was satisfactory on 25.05.2007 and the complainant was improving and removal of catheter as advised by the surgeon. Then the complainant developed Mild distension with bowel sound, then catheter was introduced to prevent retention of the urine. All investigations and treatments were routinely done and followed with all the medical parameters. The complainant inspite of the treatment given for the management of Septicemia and on routine management with higher antibiotics was not responding satisfactory. Therefore, all the necessary investigations as narrated were done. Then the Opposite parties have further contended that right from the date of the admission on 02.05.2007 till her discharge on 01.06.2007, there was no bladder rupture as alleged by the complainant and therefore there was no need for performing Laprotomy, if at all there were to be bladder rupture, the complainant would have passed blood in urine and there could not have been bladder rupture and retension of urine requiring catheterization. The Ultrasound done shown urinary bladder normal with 600 ml urine unit, which is not possible even if there was a minute rupture of urinary bladder. The C.T. scan of pelvis was also found normal. Therefore, there was no scope for that in intervening for bladder rupture. The Opposite parties have further commenting upon the allegations of the complainant about her father suspecting some problem with the treatment of Opposite parties got the complainant shifted to seventh Opposite party hospital has been commented as rediculus stating that the father of the complainant was not a professionalist and competent to speak on the method of treatment given to the complainant. The Opposite parties further denying all other allegations and deficiency in their service further denied their liability to compensate the complainant and thus have prayed for dismissal of the complaint.<br /> 4. In the course of enquiry into the complaint, the complainant has filed her affidavit evidence, examined 3 witnesses namely Dr.Chandrashekar S.Rathkal Professor and Head of the Department of Nephro-urologist, Victoria Hospital, Dr.B.R.Nagaraju, Professor, Radio diagnosis, Victoria Hospital, and one Dr.Roopa.R.Babladkar an Aurvedic medicine graduate. The Opposite parties 2 to 6 have filed their affidavit evidence and one Chandrashekaraiah for first Opposite party, the Administrative Officer has also filed affidavit evidence. Counsel for the Opposite parties has subjected the complainant’s witnesses to cross-examination. The counsel for the complainant has cross-examined the Opposite parties 2 to 6. The complainant has got marked 11 exhibits, which are ultra sound scan of abdomen, CT Cystogram report, admission record of Victoria Hospital, consent to surgery and anesthesia, history and progress sheet, discharge summary, abdominal ultra sonography report of first Opposite party hospital, cystology report as per Ex.C.9 to 11, has also produced the bills of the hospitals. Opposite parties 1 to 6 produced the case sheet of this complainant. Heard the counsel for both the parties and perused the records. <br /> 5. On the above contentions, following points for determination arise.<br /> 1. Whether the complainant proves that Opposite parties 2 to 6 while treating her in the first Opposite party hospital caused rupture of her urinary bladder and thereby that the opposite parties 1 to 6 have caused deficiency in their service in not further diagnosing and treating it?<br /> 2. Whether the complainant is entitled for the relief sought for? <br /> 6. Our findings are as under:-<br /> Point no.1 : In the Negative.<br /> Point no.2 : See the final order.<br /> <br /> REASONS<br /> <br /> 7. Point no. 1:- It is undisputed that, the complainant was a pregnant with expected date of delivery on 30.04.2007 was admitted to first Opposite party hospital on 02.05.2007 for safe delivery. It is also not in dispute that the complainant went into labour spontaneously on 03.05.2007 at 5.30 am and delivered a live normal male baby at 9.15 am on the same day and she was normal after delivery. The complainant was also found in normal health except she did not pass stool on 04.05.2007. But, on 05.05.2007 she developed fever with chills, mild abdominal distension and chest pain. It is from this date, the complainant developed some health problems and it is thereafter Opposite parties 2 to 6 have treated the complainant in the first Opposite party hospital and stated to had discharged her on 01.06.2007 after finding the complainant health was normal. But, the complainant who was inserted with the catheter for free passing of urine because of the problem of urine retention was advised to approach the Opposite parties after 15 days after the dischargel and was on medicine. But, the complainant stated to had got admitted to the seventh Opposite party hospital on 02.06.2007, then she was referred to Urology Department on 09.06.2007, C.T. scanning was got done in Boring hospital, Bangalore and report of the C.T. scanning dated 07.06.2007 disclosed rupture of the urinary bladder wherein the eight Opposite party managed to set right the urinary ruptured part of the bladder and was discharged from the hospital of seventh Opposite party on 10.08.2007. The complainant has therefore alleged that while she was under treatment of Opposite parties 1 to 6 after delivery, opposite parties 2 to 6 have caused rupture in her urinary bladder, as a result she suffered from several complications, which was not properly treated by them and thereby attributed deficiency and negligence in the service of the Opposite parties and thereby has prayed for awarding of damages.<br /> 8. The Opposite parties 1 to 6 in their version and also in the affidavit evidence have categorically stated that the complainant who got herself admitted to the hospital of first Opposite party went into labour spontaneously delivered a live male baby in the normal course without any manual or instrumental intervention, even the placenta also got separated on its own, therefore there was no chance for rupture of urinary bladder and they by totally denying that the urinary bladder had ruptured at their end at any time till the complainant was discharged from their hospital have denied the allegations of negligence and deficiency on their part. The complainant has filed the complaint by narrating the whole development that took place in the hospital of the first Opposite party, treatments given by Opposite parties 2 to 6 and chine of events and treatments that was given in the hospital of first Opposite party. The Opposite parties have also filed their version and affidavit evidence reproduced important notings of the case sheet maintained in connection with the delivery of the complainant and treatment given to her in the course of her stay in the first Opposite party hospital and thus the complaint, version and their affidavit evidence found to be self explanatory as to the course employed by the Opposite parties 1 to 6. In the treatment of the complainant and to find out whether the Opposite parties 1 to 6 were negligent or not and whether their act or omissions is deficient of their service.<br /> 9. As could be seen from the materials placed before this Forum by the respective parties and the entire case sheet produced by the Opposite parties 1 to 6 after the complainant delivered a baby on 03.05.2007 she was normal on 03.05.2007 and also on 04.05.2007. But, the complainant on 05.05.2007 complained of abdominal distension, then she was advised temperature chart and abdominal girth chart and she was given antibiotics and was referred to physician. At 8.15 pm, physician examined the complainant and advised ECG suspected Myocarditis, advised cardio enzymes and prescribed certain medicines. Then the patient had difficulty in breathing, on the same day was shifted to ICCU and advised continues ryle’s tube aspiration and catheterization of bladder. On the same day at 9.00 pm the surgeon examined, paralytic ileus suspected advised to continue ryle’s tube aspiration and catheterization of bladder, advised for abdomen X-ray to test urea creatinine, serum electrolytes and then the complainant was monitored by the duty doctors and urine output was found 950 ml on 05.05.2007. On 06.05.2007 at 4.45 am the complainant was referred to Urologist, Surgeon, Physician and Nephrologist. Urea – 80 mg/dl, epatimin – 3.3 and found plenty of pus cells in urine and 6 – 8 RBC cells. Then Nephrologist advised Eco-urine Analysis and necessary medicines were given. The complainant was monitored through out, then she was diagnosed for acute renal failure, septicemia, and abdominal distension. On 07.05.2007 Surgeon, Physician, Nephrologist, and all specialists examined the complainant advised urine and blood culture and was given antibiotics. Anaeshtetist report was also sought in advance if incubation is required on that day, renal function found improved. On 08.05.2007 at 9.45 am, the complainant was found better and urine output was 1600 ml, antibiotics and other treatments were continued and the doctors were found visiting regularly. Here, we emphasise the noting of urine output through the stay of the complainant in seventh opposite party hospital, which is in our view is indicative of the fact whether there could have been rupture of urinary bladder or not. On 09.05.2007 condition of the complainant improved, urine output was found 700 ml, then she was advised oral liquids, ryle’s tube removed and the doctors continued to attend and monitored. On 10.05.2007 complainant condition was found stable, treatments were continued and the patient was monitored regularly. But, the complainant at 3.55 pm complained sever pain in the abdomen, RTA – 200 ml was noted. On 11.05.2007 complainant condition was stable, montoux test was done, opinion of surgeon, nephrologist and pulmonologist, was sought input was found 2000 ml and output was 300 ml. Then X-ray showed minimal pleural effusion monitoring the patient and treatment continued, septic fluid aspiration was sent for analysis and pleural fluid aspiration was sent for protein, sugar, LDH cell type, cell count, GFB gram stain, culture and sensitivity advised. At 6.30 pm consent for central venous catheterization taken from the complainant’s father, it was done under anaesthesia. On 12.05.2007 abdominal distension continued to be same. RTA was 1400 ml, urea – 39, creatinine – 0.9, NA+136, K+3.9, CT – 102, by 10.00 pm RTA was 200 ml. On 13.05.2007 condition remained the same, doctors attended her, monitored specific fluid sent for analysis, suspecting peritonitis, surgeon and nephrologist visited and monitored the condition. On 14.05.2007 Monitarux test – negative, Moderate left pleural effusion with partial collapse of the left lung, Mild right plural effusion distension + RTA – 245 ml. On 15.05.2007 CT scan of Thorox and abdomen showed pleural effusion moderate in left lung and mild in left lung. Consent taken from husband for intercostals chest drain placement and flank drain and procedure was done and drained about 150 ml of fluid. On 16.05.2007 Pedal oedema + ascitic drain – 500 ml, Pleural fluid – 750 ml, general condition was normal, distension + RTA -170ml, vitals monitored by experts. On 17.05.2007 she was monitored Specialists reviewed the case. Intercostals drainage was done, chest X-ray repeated and she was found better. On 19.05.2007 Pleural – 90 ml, ascitic – 50 ml. G.C. satisfactory distension + urine culture – condition was found better. On 21.05.2007 abdominal distension was found, scanning was advised to rule out inter loop abscess, urine output was 1000 ml. On 22.05.2007 pleural drain – 5 ml, urine output was 3100 ml, abdominal distension was found. On 23.05.2007 pleural drain – 10 ml, urine output was 3900 ml, abdominal distension was found. On 24.05.2007 urine was found 2300 ml, abdominal distension was found, antibiotics continued as the advised earlier. On 25.05.2007 drain was nil, urine fluid was nil. On 26.05.2007 urine output was 1400 ml, no distension in the morning, she complained abdominal pain, catheterization was done in the afternoon. On 27.05.2007 at 12.00 am urine output was 2650 ml, no distension, ICD – removed. On 28.05.2007 abdominal distension was their advised to investigate for retention of urine by the Urologist, then the Urologist advised catheterization till the patient is mobilized and Urologist advised no other urological intervention was required. On 29.05.2007 urine was 1500 ml + distension on 30.05.2007 urine was 2600 ml, general condition was found satisfactory. On 31.05.2007 the general condition of the complainant was satisfactory. At 10.42 am catheter was removed, but after some time say at 2.00 pm she developed problem of passing less quantity of urine frequently by straining, then Urologist opinion was sought, then catheterization was done as per the advise of the Urologist, then the complainant was discharged on 01.06.2007 with catheter with foley’s catheter with antibiotics and to approach the opposite parties 1 to 6 for review after 15 days. This is was the monitoring the treatment and the condition of the complainant that could be found while she was found in the hospital of the first op after the delivery and when her abdominal problem started from 05.05.2007 till she was discharged on 01.06.2007.<br /> 10. The learned counsel appearing for the complainant in the course of arguments after inviting our attention to the entire case sheet maintained by the first opposite party during the course of treatment of this complainant could not point out any latches or negligence with regard to the treatment given to the complainant by opposite parties 2 to 6. But, invited our attention to erect X-ray abdomen done on 05.05.2007 on the complainant and argued that the report of the erect X-ray abdomen disclosed ground glass appearance and therefore opposite parties 2 to 6 should have though of the rupture of urinary bladder of the complainant and that leakage of urine from the bladder as given ground glass appearance and therefore submitted that the opposite parties have caused rupture in the urinary bladder, but have failed to diagnose it and to treat the complainant effectively. The learned counsel to substantiate this contention has relied on the evidence of a witness Dr.Chandrashekar S.Rathkal, Professor, Head of Department of Nephro-Urology, Victoria Hospital, evidence of Dr.B.R.Nagaraju, Professor, Radio Diagnosis, Victoria Hospital, and another Dr.Roopa R.Babladkar who has done medical graduation in Aurvedic medicine and subjected opposite parties 2 to n6 for cross-examination to elicit that urinary bladder of the complainant was damaged by these opposite parties 2 to 6, while they were treating the complainant in the hospital of first opposite party. The learned counsel representing the complainant did not dispute the fact that in the normal delivery cases, the question of rupturing urinary bladder is very rare and all most there is no possibility and even admitted as stated above, that the complainant delivered a baby in her normal delivery without any sort of intervention and even the placenta got itself detached. However, the counsel for the complainant submitted that while the child was still in the womb, there are chances of the child kicking and that may result in the rupture of urinary bladder and therefore submitted in the case on hand rupture of urinary bladder because of the child kick has happened but the opposite parties did not take care to diagnosis it. The learned counsel in support of his arguments relied on the commentary 0n the book Short Practice of Surgery by Biley and Love’s and text book of Obstetrics by D.C.Datta. In this book there is caption called rupture of the bladder. It says “This may be intra peritoneal (20%) or extra peritoneal (80%). Intra peritoneal rupture may be secondary to a blow kick or fall on a fully distended bladder and it is more common in the male than in the female and usually follows a about beer drinking. More rarely it is due to surgical damage extra peritoneal rupture is usually cased by the fractured pelvis or secondary to major trauma or surgical damage”. This commentary do not further say that bladder may get ruptured because of a kick by the child inside the womb and the learned counsel for the complainant has not brought to our notice any such commentary or opinion of the experts that bladder of the complainant had ruptured, because of the kick of the child prior to delivering the baby. Therefore, this commentary on the subject in our view will not help the complainant to prove that urinary bladder of the complainant had ruptured by the time the baby was delivered or even when the complainant was in the hospital of first opposite party.<br /> 11. The witness Dr.Chandrashekara S.Rathkal in his evidence has stated that the complainant was admitted in their hospital that she had given ultra sonography report taken in the first opposite party hospital as per Ex.C.7 and ultra sonography report of the thorox as per Ex.C.8 to him, but stated that he cannot say how many days back the urinary bladder of the complainant had ruptured by the time he examined her in their hospital. He has also stated that he cannot also say how many days back prior to his examination debries had formed. But, stated that bladder had ruptured by the time, the complainant went to their hospital. Of course, this witness has further stated during the course of delivery, there is possibility of rupture of urinary bladder. The witness in the cross-examination of the counsel for the opposite parties 1 to 6 has stated that the complainant got admitted to their hospital on 09.06.2007 and he examined her on that day and the witness in the cross-examination admitted that Ex.C.7 and 8, the scanning reports that got prepared by opposite parties 1 to 6 in their hospital, in which he do not see the rupture of the bladder. The other witness doctor Nagaraju has only deposed to had referred the complainant for ultrasound scanning of abdomen and pelvis and depose to had got the C.T scanning report as per Ex.C.2 whose evidence will not in any way is helpful to either parties. The complainant has further relied upon the evidence of the witness Dr.Roopa R.Bubladkar. This witness has been examined by the complainant as an expert to speak to the negligence of opposite parties 1 to 6 in treating the complainant. This witness in her affidavit evidence deposing on the basis of the case history has stated an erect X-ray abdomen was taken and its report revealed ground glass appearance, which is indicative of fluid in the lower abdomen and stated that obstetrician could have had a though of bladder rupture and refer the patient to Urologist and further stated bladder rupture in this case might have occurred during delivery or during removal of placenta and stated that bladder rupture is a common phenomenon during the course of delivery and stated that in her opinion there is a negligence on the part of the team who attended the complainant. <br /> 12. The learned counsel basing on this erect X-ray abdomen report, which gave ground glass appearance and also basing on the evidence of Dr.Roopa R.Babladkar submitted that the opposite parties after finding the report of ground glass appearance in the erect X-ray abdomen should have thought of rupture of the bladder, but they did not takes steps to identify and thereby submitted that it is that negligence of these opposite parties 1 to 6 at that stage has resulted in trauma to the complainant who suffered at their hands and was forced to approach seventh and eight opposite parties for the relief of managing the ruptured bladder and thereby attributed deficiency in the service of opposite parties 1 to 6. It is this alleged negligence or omission of opposite parties 1 to 6 to identify the bladder rupture is a trump card of the counsel for the complainant to attribute deficiency. But, it could be seen, that the opposite parties 1 to 6 even after taking erect x-ray abdomen on 05.05.2007 which gave ground glass appearance did not leave the case at that stage. They on 06.05.2007 sought the opinion of Nephrologist and other experts to monitor the complainant and that opposite parties 2 to 6 have even done abdominal ultra sonography on 07.05.2007 in which urinary bladder was found normal. Again on 11.05.2007 abdominal ultra sonography report iss taken even that also disclosed that the urinary bladder was over distended with 600 ml volume. Even the witness of the complainant Dr.Chandrashekar S.Rathkal himself in the cross-examination itself has stated that ultra sonography report of thorox and abdomen Ex.C.7 and 8 taken in the hospital of first opposite party do not that disclose rupture of urinary bladder. Therefore, we do not find any substance in the contention of the complainant and the counsel for her that the opposite parties 1 to 6 did not think of identifying the rupture of urinary bladder after they found ground glass appearance in the erect X-ray of abdomen. <br /> 13. Further in coming to the evidence of the complainant’s witness Dr.Roopa R.Babladkar in the cross-examination she has admitted that as seen from the case history during the course of treatment, number of medical experts and specialists have attended the complainant and this witness has also admitted that on 07.05.2007 the complainant was suffering from septicemia and specific medicines were prescribed by the doctors and also admitted that despite administering medicines, it is very difficult to control septicemia. It is the contention of the opposite parties 1 to 6 that there are many reasons which give ground glass appearance in the erect abdominal x-ray and the counsel for the opposite parties argued that there are no merits in the contention of the counsel for the complainant that it was because of the rupture of the bladder, urine came out collected in the abdominal cavity and that has given ground glass appearance. He further submitted that after delivery, the chance of small quantity of fluid collecting in the abdominal cavity and pelvis is common and that would also give ground glass appearance and when cross-examined Dr.Roopa R.Babladkar, this witness has stated she cannot specify the various types of fluids that would give ground glass appearance and stated that a Gynecologist or an obstetrician can give opinion that which are fluids that would give ground glass appearance. The expert witness for the complainant further in the cross-examination admitted stating that X-ray report of the complainant revealed ground glass appearance, and admitted the fluid shown in the X-ray rules out blood and urine. The witness also stated that she is seeing a note made in the case sheet on 14.05.2007 at page No.55 on the reverse side that note is based on CT scan, which further suggests abdominal organs such as lever, bladder were normal and it is also suggestive of fluid. The witness further admitted in the cross that the bladder rupture will have the following features; namely inability in passing urine, urine with blood, passing little quantity of urine and no possibility of urine retention, and admitted that in case of bladder rupture, urine passes on to peritoneal cavity and there will not be no retention, but the witness voluntered that it depends upon the trauma to the mucosa of the bladder. The witness further admitted, in the case of complainant, urine has not passed on through the blood. To the suggestion made by the counsel for the Opposite parties suggesting that nowhere in the world in the standard text books of Obstetrician mentions about bladder rupture in normal delivery. The witness answered she can produce the authority basing on the authors view, but the witness has not produced any such authority or views of the author regarding rupture of bladder in case of normal delivery. Hence, further admitted that she has not independently done any normal deliveries. But, she has done under the guidance of Gynecologist. The witness further admitted that there was no complications during delivery and after delivery in this case and the complainant also did not complain trauma at the time of admission. The witness in the cross-examination further admitted that she has referred to a text book of Obstetrician by D.C.Datta page No.155 under the title Urinary Tract who has said that bladder wall become yedematoes and hyperemic and often shown evidence of sub mucous extravagations of blood, because of relative insensitivity to the raised intravesal pressure due to trauma sustained to the nerve plexus during delivery the bladder may be over distended without any desire to pass urine. The witness to the suggestion of the counsel for the Opposite parties admitted that the opinion of the above author applies in the case of prolonged labour, caesarian, forceps delivery and surgical intervention. Therefore, the evidence of this witness basing on the observation of the book by D.C.Datta has no bearing to the case rupture of bladder in normal delivery. The witness also admitted that she do not have any authority to prove that bladder rupture is a common phenomenon during the course of delivery. The witness further referring to report dated 11.05.2007 of abdominal ultra sonography report, she has stated that she cannot say the extent of rupture of the bladder and further admitted, in the same report she saw mentioning of 600 ml of urine in the bladder. But, denied the suggestion if there were to be bladder rupture, 600 ml of urine would not have collected in the bladder. She has also further admitted that this report do not suggests any rupture of bladder. She has also admitted that catheter was inserted to the complainant on 05.05.2007 for draining out urine.<br /> 14. It is on going through the evidence of all the witnesses examined by the complainant and particularly the so called expert namely Dr.Roopa R.Babladkar, it is not possible to say that there was bladder rupture when the complainant was monitored by Opposite parties 2 to 6 in the hospital of first Opposite party. The counsel for the complainant while cross-examining the fifth Opposite party has elicited that if ground glass appearance is found in the erect abdomen X-ray, it may be diagnosed as Intra peritoneal rupture as opined by the author Biley and Love’s on Short Practice of Surgery. But, the witness volunteered that ground glass appearance may happen for many reasons and presence of fluid in the abdomen would give ground glass appearance, therefore it cannot be said that ground glass appearance in the erect abdomen X-ray itself is suggestion of rupture of urinary bladder. As found from the evidence of this witness, ground glass appearance may be seen for several reasons including the presence of fluid in the abdomen. It is to be borne in mind that the complainant had delivered 2 days prior to 05.05.2007 and that small quantity of fluid in the abdominal cavity and pelvis cannot be ruled out and the same was taken care of by Opposite parties 2 to 6 by draining it out by insertion of ryle’s tube. In the cross-examination of second Opposite party, the obstetrician who monitored the delivery, the counsel for the complainant has not been able to elicit any evidence in connection with rupture of urinary bladder. Coming to the cross-examination of third Opposite party, this witness has stated after seeing the abdominal distension he referred the complainant for opinion of the surgeon and stated that the abdominal distension was because the complainant had delivered a baby 3 days earlier and that distension might be, because of that reason, therefore he did not think of taking further steps in that regard. The witness in the cross-examination has stated that in order to know the cause for ground glass appearance they got ascetics fluid analysis, which suggested pus in the peritoneal cavity. Even at that stage, they ruled out rupture of urinary bladder because patient was draining normal quantity of urine through foley’s catheter and ultrasound abdomen showed no evidence of bladder rupture and CT scan abdomen showed no evidence of bladder rupture. The evidence of this witness has also not been controverted with regard to the examination they did ruling out the possibility of the bladder rupture. The suggestion of the counsel for the complainant that they should have inferred urinary bladder rupture on the basis of the X-ray report dated 05.05.2007 is denied by the witness referring to the report of confirmation of intactness of the urinary bladder. The witness in the further cross-examination stated that case sheet dated 06.05.2007 itself leads to suspecting urinary tract infection and thus the counsel for the complainant has not been able to elicit any evidence from this witness to speak to any sort of short comings or negligence in that witness in treating the complainant. The counsel for the complainant has also subjected sixth Opposite party for cross-examination who is the surgeon who attended the complainant, has stated that there was retention of urine in the bladder, therefore the complainant was continuously catheterized. This witness further admitted to had advised for removal of the catheter, but on further coming to know distention of the abdomen, whenever the catheter was removed, he advised for continued catheterization. Thus on going through the evidence of Opposite parties 2 to 6 and their cross-examination we failed to note any short comings or negligence in those doctors treating the complainant like any other ordinary and prudent doctor could have done. These Opposite parties on other hand being specialists of their branches through out closely monitored the complainant examined all ways and means to arrest the abnormalities of the complainant when she developed septicemia. The evidence on record, which is in abundance rule out the possibility of bladder rupture at any time right from the date of admission till the date of discharge. The un controverted evidence of Opposite parties 2 to 6 that they through out from 05.05.2007 till 31.05.2007 they tested the complainant for abdominal distention, which was the result of retention of the urine in the bladder and therefore they had to continuously catheterize the complainant with a view to drain out the bladder in not rebutted on the other hand it is admitted. In case if there had been any rupture in the urinary bladder even if it were to be a minor one, it would have led the urine passing on to abdominal cavity and pelvis and that could not have been any chance for over distention of the bladder. As found from the case sheet and the evidence of the witness, except the small quantity of fluid found in the abdominal cavity and pelvis after the deliver, which same was drained out thereafter no fluid was found in the abdominal cavity or in the pelvis. This unrebutted evidence of Opposite parties 2 to 6 falsifies the allegations of the complainant that they had caused rupture of urinary bladder. As such we find no merits in the contention of the complainant.<br /> 15. No doubt after the complainant was got discharged from the first Opposite party hospital on 01.06.2007 she went to the hospital of seventh and eight Opposite parties got admitted to Victoria Hospital on 02.06.2007, then she was referred to Urology Department on 09.06.2007 and it is stated on 05.06.2007 when ultra sonography was done in seventh Opposite party, the Victoria Hospital using B – mode real time gray scale they found discontinuity noted in the postero lateral wall of bladder measuring 2.5 Complaint with mucosal irregularity and floating debries with loculated collection in the pelvis with minimal ascetics and to get confirmed the bladder rupture, CT scanning was done at Bowring Hospital and got the report on 07.06.2007, which confirmed the rupture of the bladder. Therefore, it is seen, for the unfortunate of this complainant after she was got discharged on 01.06.2007 and by the time she was subjected to ultra sonography and scanning on 05.06.2007, the seventh and eight Opposite parties discovered the rupture of urinary bladder and that was managed by them later on. For this, the complainant wants to hold Opposite parties 1 to 6 as responsible. But we do not find any positive evidence to concur with the claim of the complainant to fix Opposite parties 1 to 6 as liable for rupture of the urinary bladder, where, when and how the urinary bladder of the complainant got ruptured has remained as a mistery. However, in the absence of positive evidence against Opposite parties 1 to 6 this Forum cannot hold Opposite parties 1 to 6 as negligent and or deficient in their service.<br /> 16. The learned counsel for the complainant in support of his arguments that these Opposite parties 1 to 6 are deficient in their service has relied on two decisions reported in I (2007) CPJ page 451 and another decision III (2007) CPJ page 189 of NC. In the first decision the Hon’ble National Commission has held that the burden is on the hospital or doctors to dispute the allegations of the negligence made by the complainant, but that view has been expressed when the maximum resipsa loquiter is applied. In the second case the Hon’ble National Commission found the doctor has deficient, in that doctor having had not diagnosed properly by undertaking deeper investigation. These cases have no bearing to the facts of this case. The learned counsel appearing for the Opposite parties arguing in defence of Opposite parties 1 to 6 invited our attention to the elaborated entries made in the case sheet, and the service rendered by the Opposite parties 2 to 6, stated that the complainant was normal when she was admitted to the hospital and it was a normal delivery of the complainant, but problem started from 05.05.2007 which led to septicemia, renal failure, which have been effectively attended with all care and prescriptions. He further argued that the complainant has failed to point to the negligence of these Opposite parties 1 to 6 in the course of their attending the complainant. He further argued that the treatment given by the opposite parties and care taken is more than a doctor of ordinary and prudent doctor could more taken adopted by the opposite parties 1 to 6 through out to drain out urine from the bladder when it got over distended and argued that speak in volumes to falsify the allegation of the bladder rupture and submitted the complainant has not been able to prove the negligence of any of the Opposite parties 1 to 6 and therefore submitted for dismissal of the complaint by relying upon decisions of the Hon’ble Supreme Court reported in III (2005) CPJ 9, AIR 1996 Supreme Court page 2111 and II (2006) CPJ page 80 (NC) and few other decisions. He further argued that the specialist doctor examined by the complainant namely Dr.Roopa R.Badladkar is only an Aurvedic Physician not allowed to practice allopathic medicines has attempted to find false with the expert and specialist doctors like Opposite parties 2 to 6, which cannot be believed on the ground she is not competent to do so and relied on a decision reported in IV (2007) CPJ 295 (NC). He further argued that the complainant who was discharged on 01.06.2007 with catheter was advised to get back to first Opposite party for review, but she did not turn up and went to seventh and eight Opposite parties and stated if the complainant had approached the Opposite parties they would have done what was required and what has been done by seventh and eight Opposite parties. For such an omission on the part of the complainant in approaching the Opposite parties, the Opposite parties cannot be blamed and thus relied upon a decision reported in II (2007) CPJ 327 NC. It is on going through the decisions relied upon by the counsel for the Opposite parties, we hold that the burden of proof, is on the complainant who alleges negligence or deficiency in the service of Professional Doctors to prove negligence of a doctor or hospital. In such an event, the complainant has to lead adequate evidence in support through an expert or experts or medical literature. In the absence of such cogent evidence allegation of the complainant cannot be a substitute for proof and therefore we hold that the complainant has failed to prove the negligence of Opposite parties 1 to 6 or the deficiency in their service. The complainant has made seventh and eight Opposite parties as formal parties against whom no allegations of negligence or deficiency is made. As such, complaint in our view is liable to be dismissed and therefore we answer point no.1 in the negative and hold that the complaint is liable to be dismissed and pass the following order. <br /> ORDER<br /> <br /> 1. The Complaint is dismissed.<br /> 2. Parties to bear their own costs.<br /> 3. Give a copy of this order to each party according to Rules.<br /> <br /> (Dictated to the Stenographer, transcribed by her, transcript revised by us and then pronounced in the open Forum on this the day 25th September 2008)<br /> <br /> <br /> <br /> <br /> <br /> (D.Krishnappa) <br /> President <br /> <br /> <br /> (Shivakumar.J.)Member<br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> 02.05.2007 Admitted for delivery with 40 week 2 days of pregnancy she had no problems during pregnancy.<br /> 03.05.2007 Delivered at 9.15 am a male baby normally her condition was normal.<br /> 04.05.2007 Patient not passed stool.<br /> 05.05.2007 Passed motion and complained of abdominal distention advived temperature chart and abdominal girth chart. Antibiotics and analgesies given complained chest pain referred to physician at 8.00 pm.<br /> At 8.15 pm physician examined pulse 120 Tachycardia + NUBS + abdominal distension + sluggish bowel sounds.<br /> ECG done :- ? Myocarditis suspected advised Cardia enzymes, medamal tablet and injection pan lamp I.V.<br /> Advised ECG after 1 hour and to monitor B.P., pulse and to get surgery opinion as emergency.<br /> Patient had difficulty in breathing. Shifted to ICCU and advised continuous Ryles tube aspiration and catheterization of bladder.<br /> At 9 pm surgeon examined paralytic ileus was suspected. Advised to continue ryles tube aspiration, catheterization of bladder, IV fluids and advised erect abdomen X-ray, to test urea, creatinine, serum electrolytes and RBS. Senior duty doctor examined her at 9.30 pm, 12.00 midnight, 2 am and 4 am. Blood urea was 80 mg/. Creatinine – 3.3.mg/dl. B.P. 90/70 mm Hg pulse 160/min. at 4.30 an electrolytes result showed Na+ 130, K+ - 44, cl- 97. RBS 110 mg/dl. Urine out put was 950 ml. SPO2 – 98%, referred to physician and nephrologist.<br /> 06.05.2007 At 4.45 am referred to urologist, surgeon, physician and nephrologist.<br /> Urea – 80 mg/dl epatimin – 3.3 and plenty of pus cells in urine and 6 – 8 RBC cells. Nephrologist – advised Echo and Urine analysis Methogyl 100 ml. 8th hourly, suspected acute renal failure and myocarditis. At 6.00 am, 8 am, 8.30 am, 11.00 am, 11.30 am, 11.40 am, 1 pm, 5 pm, 8.30 pm, 11 pm, the patient was continuous monitored.<br /> Confirmed myocarditis with acute renal failure, septcarmia and abdominal distension.<br /> 07.05.2007 All the specialists examined. Advised urine and blood culture and treated with antibiotics, IV fluids and tablets. Referred the patient to pulmologist and shift to RICU. Doctors attended on her at 9 am, 2.30 pm, 3 pm, 8.30 pm, 4.15 pm, 8 pm, 9 pm, 11.15 pm. Anaeshtetist report was also sought in advance if incubation is required. Renal function improved.<br /> 08.05.2007 9.45 am patient was better urine out put was 1600 ml and antibiotic and others treatments were continued. Specialists visited. Ryles tube aspiration was 500 ml and it was changed Patient passed stool. Nil orally and IV continued. Doctors visited at regular intervals and monitored.<br /> 09.05.2007 Condition improved RTA – 30 ml urine output 700 ml. Oral liquids advised urea – 69 creatinine – 1.0 Na+ 144, K+ 3.5, Cl-15b Ryles tube removed. Doctors visited several times and monitored.<br /> 10.05.2007 Condition was stable. Treatments were continued. Vaginal swab repess showed enterococci bacteria and sensitive to amoxycilthin, amplicillin, cefotoxime and ciprofloxanine. Advised blood and urine tests. Specific antiobitic started (page 40). At 3.55 pm complained severe pain in the abdoment RTA – 200 ml.<br /> At 4.00 pm contacted surgeon and physician were informed for their opinion. Patient was regularly monitored at regular intervals.<br /> 11.05.2007 Patient’s condition was stable. Montenx test done surgeon, nephrologists and pulmologists opinion sought, input was 2000 ml output was 300 ml. chest X-ray showed minimal pleural effusion monitoring the patient and treatment continued secitic fluid aspiration was sent for analysis and pleural fluid aspiration was sent for protein, sugar, LDH, cell type, cell count, GFB gram stain, culture and sensitivity advised. At 6.30 pm consent for central venous catheterization taken from father and it was done under anaesthesia.<br /> 12.05.2007 Abdominal distension continued to be same.<br /> RTA – 1400 ml.<br /> Urea – 39, creatinine – 0.9, Na+ 136, K+ 3.9<br /> Ct – 102<br /> By 10 pm – RTA 200 ml.<br /> 13.05.2007 Condition remained same. Distension doctors visited several times and monitored specific fluid sent for analysis, suspected penitonitis. Surgeon and nephrologists, visited monitored the condition.<br /> 14.05.2007 Monitarux test – negative. Moderate left pleural effusion with partial collapse of the left lung. Mild right plural effusion distension + RTA – 245 ml.<br /> 15.05.2007 CT scan of thorax and abdomen showed plural effusion moderate in left lung and mild in left lung. Consent taken from husband for intercostals chest drain placement and flank drain and procedure was done and drained about 150 ml. of fluid.<br /> 16.05.2007 Pedal oedema + ascetic drain – 500 ml. Pleural fluid – 750 ml.<br /> Gen.l condition normal, distension + RTA -170ml, vitals monitored by experts.<br /> 17.05.2007 General condition fair – RTA – 40 ml. Ascetic – 200ml. Pleural – 200 ml. distension + vitals monitored.<br /> 18.05.2007 Pedal oedema + General condition – fair.<br /> Pleural fluid – 50 ml. Ascetic – 100 ml.<br /> Specialists reviewed the case. Intercostals drainage done, chest X-ray repeated. PF fair better.<br /> 19.05.2007 Pleural – 90 ml ascetic – 50 ml. G.C. satisfactory distension + urine culture – condition +++<br /> 20.05.2007 G.C. – fair<br /> Pleural fluid – 50 ml. ascetic – 45 ml.<br /> 21.05.2007 Distension + scanning advised to rule out interloop abscess. No pleural drain urine output 1000 ml.<br /> 22.05.2007 Pleural drain – 5 ml. Urine output 3100 ml. Distension +<br /> 23.05.2007 Pleural drain – 10 ml. Urine out put 3900 ml. Distension +<br /> 24.05.2007 Drain – nil. Urine 2300 ml. Distension + antibiotics continued as earlier.<br /> 25.05.2007 Drain – nil. Urine 1200 ml. Catheter removed, no distension free fluid – nil.<br /> 26.05.2007 Drain – nil, urine – 1400 ml. No distension in the morning complaint abdominal pain. Catheterized in the afternoon.<br /> 27.05.2007 At 12.00 am – urine 2650 ml. No distension. ICD – removed.<br /> 28.05.2007 Distension + advised to investigate for retention of urine by urologist.<br /> Urologist advised catheterization till the patient is mobilized and no other urological intervention required.<br /> 29.05.2007 Urine 1500 ml. Distension +<br /> 30.05.2007 Urine 2600 ml. General condition satisfactory.<br /> 31.05.2007 General condition satisfactory at 10.45 am catheter removed. But patient after some time at 2 pm developed problem of passing less quantity of urine frequently by straining and urologists opinion was sought. Again catheterized as per the advice of urologist.<br /> Patient was discharged along with poly’s catheter and advised to continue antibiotics and to come for review after 15 days or earlier.<br /> She was admitted to Victoria hospital on 09.06.2007 after getting Ultrasound scanning 05.06.2007 and C.T. scan on 08.06.2007 which confirmed bladder rupture. <br /> <br />