Per Sri A. Hazarath Rao,  President:-

          The complainant filed this complaint u/s 12 of the Consumer Protection Act seeking return of Rs.2,18,480/- which was collected from him towards treatment of his wife; Rs.10,00,000/- towards medical negligence, damages and for costs.

2.   In brief the averments of the complaint are these:

          The complainant on 12-06-11 admitted his wife Anjana Devi in the hospital of the opposite parties on the advice of Dr. P. Sailaja Rani, Vijayawada for ectopic pregnancy.  The 3^rd opposite party on 13-06-11 administered 100 mg of Methotrexate IV belatedly.   Meanwhile the said Anjana Devi developed severe pain.  The 3^rd opposite party took abnormal time in giving injection and conducting laprotomy which                               caused rupture of ectopic pregnancy and lead to sepsis.                                                               The opposite parties treated the said Anjana Devi upto 24-06-11 by collecting huge amounts under different heads.  The said Anjana Devi was aged 35 years and approached the 3^rd opposite party for pregnancy confirmation.  The said Anjana Devi succumbed to death due to rupture of ectopic pregnancy and also due to septicemia and all opposite parties are responsible.   The 3^rd opposite party did not take proper care and diagnostic method to ascertain the nature of illness.   The opposite parties created seriousness on the illness of the said Anjana Devi and obtained number of documents from the complainant and the attendants.  The action and in action of the opposite parties in treatment caused unfortunate and sudden unnatural death of the said Anjana Devi.   The opposite parties collected Rs.218,480/- from the complainant towards medical expenses.   The opposite parties gave reply with false allegations to the notice issued by the complainant. The complainant claimed Rs.10,00,000/- as damages.

3.   The 2^nd opposite party filed memo adopting the version of the opposite parties 1 and 3.

On 12-06-11 the complainant’s wife Anjana Devi visited the hospital of the opposite parties on a reference by Dr. Sailaja Rani for unruptured ectopic pregnancy.  The 3^rd opposite party confirmed the earlier scan reports which suggested unruptured ectopic pregnancy.  The said Anjana Devi was in stable condition.   The 3^rd opposite party in detail explained to the said Anjana Devi about her condition, her age, importance of fallopian tube for further pregnancy, risk and complications that may arise i.e., injection to save fallopian tube and in case of failure to undergo Laparotomy.  After getting concurrence of the patient and her husband the 3^rd opposite party proceeded further.  The said Anjana Devi complained severe pain in abdomen on the next day when the doctor was about to leave for surgery.   The said Anjana Devi was advised to undergo scanning and the report revealed that it was a ruptured pregnancy.   The rupture is not because of drug.   Rupture may occur with or without injection.  Sometimes drug may prevent rupture.   Genital track infection is also one of the causes to get ectopic pregnancy.   The 3^rd opposite party conducted laparotomy after obtaining the required consent from the complainant.   During surgery there were adhesions between the uterus and douglas pouch.   Post operatively the said Anjana Devi went into sepsis and due to that she was shifted to ICU and treated with antibiotics and blood transfusion.   The said Anjana Devi could not be revived due to best efforts made by the 3^rd opposite party.   Merex IV was given                  at 11 p.m. on 12-06-11 but not in the morning of 13-06-11 as stated by the complainant.   The 3^rd opposite party properly diagnosed illness of the said Anjana Devi correctly and treated according to standard medical practice.  The opposite parties gave proper reply to the notice issued by the complainant.   The opposite parties treated complainant’s wife with due care, diligence and according to established medical standards and they did not commit any negligence whatsoever.   Under those circumstances, the reimbursement of medical expenses to the tune of Rs.2,18,480/- did not arise.  The complaint therefore be dismissed.

4.   Exs.A-1 to A-8 on behalf of complainant and Ex.B-1 on behalf of opposite parties were marked.   The complainant cross examined the 3^rd opposite party on her affidavit (RW1).

5.  Now the points that arose for consideration in this complaint are:

1. Whether the opposite parties committed deficiency of service?
2. Whether the complainant is entitled for refund of Rs.2,18,480/-?
3. Whether the complainant is entitled to compensation and, if so, to what amount?
4. To what relief?

6.  Admitted facts in this complaint are these:

1. The complainant got is wife Anjana Devi admitted in the     hospital of the opposite parties on 12-06-11.
2. The 3^rd opposite party diagnosed illness of the said Anjana Devi as ectopic pregnancy.
3. At the time of admission the said Anjana Devi had unruptured ectopic pregnancy.
4. The 3^rd opposite party administered merex IV (methotexate) injection to the said patient.
5. The 3^rd opposite party conducted laparotomy on the said patient and later the said patient developed sepsis post operatively.
6. The said Anjana Devi breathed her last in the hospital of the opposite parties on 24-06-11 (Exs.A-3 and A-5).
7. The opposite parties collected Rs.2,18,480/- from the complainant (Ex.A-6).
8. Exchange of notices between the complainant and the opposite parties (Exs.A-7 and A-8).

7.    The opposite parties filed affidavit of Dr. K. Gangadhar Rao expert to prove the absence of negligence.  This Forum directed the said witness to be present for cross examination by the complainant.  This Forum eschewed the affidavit of the said witness as he did not turn up for cross examination.  

8.  POINT No.1:-    The complainant filed this complaint alleging medical negligence on the part of the opposite parties for treating his wife negligently and causing her death.   The opposite parties denied negligence on their part in the death of complainant’s wife.    The initial burden is on the complainant to prove medical negligence as a negative aspect cannot be proved by adducing positive evidence.   The burden thereafter shifts to the opposite party to establish the absence of medical negligence by adducing rebuttal evidence.   An expert opinion is required in majority of the cases relating to medical negligence unless negligence can be established or inferred by ‘res ipsa loqitor’. 

9.      It is not the case of either of the parties that the patient was got admitted or admitted on 02-06-11.   Under those circumstances, the date mentioned as 02-06-11 at page 39 of Ex.B-1 should be 12-06-11.  

10.  In this case the complainant did not choose to seek expert opinion to establish medical negligence on the opposite parties.    The complainant in order to substantiate medical negligence relied on the cross examination of the 3^rd opposite party (RW1) and the treatment summary (Ex.B-1).   Ex.B-1 contains 181 pages.  Pages 180 and 181 are one and the same and relate to death summary given by RW1 and it reads as follows:

             “The patient M. Anjana Devi admitted on 12-06-11 in a stable condition with unruptured, ectopic, planned for medical management and given 100 mg of Methotrexate slow IV on 13-06-11 morning as patient c/o severe pain advised u/s pelvis repeat came as ruptured ectopic pregnancy and done laparotomy, since 14-06-2011 patient                   c/o breathlessness cough, bilateral lungs crepts + Diagnosed as flare up of sepsis because of underlying Ch.PID during surgery there were adhesions between uterus & POD and Rt. F. tube hydrosalpinx.  Then higher antibiotics started like inj:Linezolid acid and there is no rapid improvement Augmentin also started.  Inspite of all these patient is deteriorating and blood transfusion give, as O² saturation falling down, ventilator support given.  Patient expired on 24-06-11 at 6.30 pm.”       

          11.    The complainant in his complaint at para 2 mentioned that the                    3^rd opposite party gave 100 mg of Methotrexate IV and the 3^rd opposite party has taken abnormal time in giving injection, while the opposite parties contended that the 3^rd opposite party administered Methotrexate IV (Merex) on 12-06-11 itself.   RW1 in cross examination stated that the nurses administered injection merex (Methotrexate slow IV) under her supervision at about 11 pm on 12-06-11.   The learned counsel for the complainant contended that absence of coma(,) after the phrase ‘Methotrexate slow IV’ as extracted supra and thus corroborated medical negligence.   On the other hand, the learned counsel for the opposite parties contended that the persons who drafted death report were not well versed with English, the pages 39 and 40 of Ex.B-1 corroborated that merex injection was administered on 12-06-11 itself.   The words ‘R/V on 13-6-11’ at page 40 in our considered view ‘R/V’ means review corroborated the contention of the opposite parties that the 3^rd opposite party administered merex injection on 12-06-11.   The entries at page 39 and 40 of Ex.B-1 in our considered view falsified the contention of the complainant about the delay in giving Merex injection.  

 12.     The patient Anjana Devi approaching the opposite parties in stable condition with unruptured fallopian tube is not in dispute. RW1 stated that she informed the patient that there is the possibility of getting pregnancy in future if fallopian tube is preserved. RW1 (OP3) in cross examination admitted about she mentioning that the rupture is not because of drug, rupture may occur with or without injection, sometimes drug may prevent rupture.  The above admission of RW1 did not lead to an inference that administering merex caused rupture of fallopian tube in our considered opinion.    

   13.    Ectopic pregnancy is a condition in which an early embryo (fertilized egg) implants outside the normal site for implantation (uterus). Fallopian tube is the most common site of ectopic implantation, accounting for 97% of all ectopic pregnancies. Blockage of tubes or damage to tubal mucosa (causing decreased tubal motility) can impede the passage of the embryo to the uterus and results in the implantation of the embryo in the lining of the tube. The tubes cannot support the growing embryo, and may eventually rupture and bleed, resulting in a potentially catastrophic situation. Early detection and treatment of ectopic pregnancy can lead to reduced morbidity and mortality, preservation of fertility and substantial cost savings to the patient, health systems and society.  Compared to women aged 25-29 years, women above 30 years of age have a higher risk of ectopic pregnancy and higher risk for pregnancy related death, while women aged less than 25 years have a lower risk of ectopic pregnancy;

14.    Early detection of an ectopic pregnancy, the desire to retain fertility and minimizing costs and surgical morbidity are the main reasons for incorporating medical treatment as an option for managing ectopic pregnancies.   The most frequently used drug is Methotrexate (at page 373 of Gynaecology IV Edition by Robert W Shaw, David Luesley and Ash Monga).      

Management of unruptured tubal pregnancy may be a) Expectant, b) Conservative and c) Salpingectomy

Expectant Management: Where only observation is done hoping spontaneous resolution.  Indications are: (i) Falling hCG titre (ii) Ectopic mass < 4 cm. (iii) No evidence of bleeding or rupture.   There is spontaneous resolution in two third of these early cases.

Conservative management may be either medical or surgical.  Otherwise salpingectomy is done.

The advantages of conservative management are : (1) Significant reduction in operative morbidity; hospital stay as well as cost. (2) Improved chance of subsequent intrauterine pregnancy. (3) Less risk of recurrence.

Medical management: Number of chemotherapeutic agents have been used either systemic or direct local under sonographic or laparoscopic guidance) as medical management of ectopic pregnancy.  The drugs commonly used for salpingocentesis are: Methotrexate, potassium chloride, prostaglandin (PGF2α), hyperosmolarglucose or actinomycin.   The patient must be (i) haemodynamically stable, ii) tubal diameter should be less than 4 cm without any fetal cardiac activity (iii) There should be no intra abdominal haemorrhage.   For systemic therapy, a single dose of Methotrexate (MTX) 50 mg/M² is given intramuscularly.   (At page 188 Chapter 15 in the text book of Obstetrics 6^th Edition 2004 by D.C. Dutta, Management of Unruptured tubal pregnancy was dealt) 

15.    RW1 in further chief examination stated that hemoglobin level of the patient did not increase inspite of transfusion of 5 bottles of blood as she developed septicemia post operative.    RW1 denied the suggestion about the patient developing hydrosalpinx (swelling of fallopian tube) due to improper operation.   RW1 also denied the suggestion about herself and opposite parties 1 and 2 taking the patient to high risk condition in order to extract more money.   RW1 denied the suggestion about she treating the patient negligently and causing death.    

16.    In the absence of expert opinion this Forum has to rely on the literature furnished by the parties. Ectopic pregnancy itself in our considered opinion is a serious one and the advanced age of the patient also contributed further to its seriousness.   The complainant in our considered opinion failed to seek expert opinion in order to establish medical negligence on the opposite parties.   We further feel that the material on record did not establish medical negligence on the part of the opposite parties.   Therefore we opine that the opposite parties did not treat the patient negligently and answer this point against the complainant.

17.  POINTS 2 & 3:-   In view of above findings, we opine that the complainant is not entitled for return of Rs.2,18,480/- (amount incurred by the complainant towards medical expenses of his wife) and Rs.10,00,000/- as damages and answer these points also against the complainant.

18.  POINT No.4:   In view of above findings, in the result the complaint is dismissed without costs.         

Typed to my dictation by Junior Steno, corrected by me and pronounced in the open Forum dated this the 14^th day of March, 2014.

MEMBER                                  MEMBER                                PRESIDENT

APPENDIX OF EVIDENCE

Dr. Lakshmi Prasuna (OP3) RW1 examined

DOCUMENTS MARKED

For Complainant:

For opposite parties:  

        PRESIDENT

NB:   The parties are required to collect the extra sets within a month after receipt of this order either personally or through their advocate as otherwise the extra sets shall be weeded out.

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