PER VINEETA RAI, MEMBER 1. This first appeal has been filed by Dhingra Maternity & Family Welfare Clinic and its owner Mrs. K. Dhingra, Opposite Parties before the Delhi State Consumer Disputes Redressal Commission (hereinafter referred to as the State Commission) and Appellants herein being aggrieved by the order of the State Commission which had accepted the complaint of medical negligence filed by Miss Heena Joshi & others being the minor children and husband respectively of deceased Prem Lata (hereinafter referred to as the Patient). 2. As per the version of the Respondents/Complainants, Patient was got admitted in Appellant No.1/Clinic on 17.09.1993 at about 1.00 p.m. with advanced and overdue pregnancy. She had no labour pain at the time of admission. She was administered Sintocin for inducing labour by Appellant No.2, which resulted in the birth of a male child at 2.20 p.m. However, because of the high dose of Sintocin administered at one go instead of gradually and slowly as per standard medical procedure, there was rupture of the uterus and due to excessive bleeding, Patient collapsed in Appellant No.1/Clinic. Life-saving drugs such as Haemcasuly-IL were not available in the clinic and, therefore, Appellants asked Patient to be shifted to Dr. B.L. Kapoor Hospital or any other hospital but before this could be done she passed away on 17.09.1995 and was cremated the following day. Being aggrieved by the medical negligence and deficiency in the treatment of the Patient causing her death, Respondents filed a complaint before the State Commission and requested for compensation of Rs.10,00,000/- as also any other relief which was considered appropriate by the State Commission. 3. Appellants on being served filed a written rejoinder denying the above allegations. It was stated that Appellant No.2 is a highly qualified nurse/midwife with over 30 yearsexperience and she handles only normal delivery cases. In the course of examination, if she arrives at an opinion that the delivery would not be normal, she refers the cases to either Dr. B.L. Kapoor Hospital or Sucheta Kriplani Hospital. In the instant case, the Patient was brought to Appellant No.1/Clinic with an overdue condition of pregnancy and without any previous case records pertaining to any prenatal check-ups. When the Patient was placed on the table for examination, she screamed and went into precipitate labour and Appellant No.2 had no option but to handle the delivery in her clinic. A male child was born and placenta and membrane were fully delivered. However, thereafter the uterus became atonic which means that it was not contracting and there was extensive bleeding. Appellant No.2 proceeded to massage externally to facilitate uterine contraction and Methergin 0.2 mg was intravenously administered as also the Dextrose drip. However, on finding that the uterus was still in an atonic stage, Appellant No.2 as per standard medical procedure put the Patient on a drip of Pitocin, which also contained Oxytocin as it is universally acknowledged that this medication is necessary to control hemorrhage before taking the ultimate decision for hysterectomy. Appellant No.2 also simultaneously contacted nearby hospitals to move the Patient from her clinic and finally Dr. B.L. Kapoor Hospital, which is a hospital nearest to the clinic, agreed to receive the Patient and to conduct the required hysterectomy. According to the Appellant No.2, Patient was taken by the mother and relatives alive from the clinic of Appellant No.2 even though the excessive bleeding had not stopped. It was contended that the Patient died at her residence and not in Appellant No.1/Clinic, which means that the Patient did not heed Appellantsadvice to take her to the hospital. There was no medical negligence in the treatment of this Patient and the drugs prescribed to her were after the delivery to check the hemorrhage and not prior to the delivery to precipitate the labour as wrongly contended by the Respondents/Complainants. 4. The State Commission after hearing the parties and on the basis of evidence produced before it allowed the complaint by observing as follows : 6. On examining the defence of OPs on the anvil of aforesaid criteria we find that this is a case of utter and grossest kind of negligence. Firstly the OP No.2 was not at all a qualified person to undertake the delivery. She was only a Midwife. Any person who does not possess the requisite skill or qualification is not entitled to take up the case even if he or she has a wide experience of dealing with delivery cases. Firstly she should not have taken the case and secondly she was not competent to confront with the complications arising from precipitate labour as the deceased was brought in overdue condition of pregnancy. The precipitate labour is known to be followed by acute hemorrhage and this situation could not have been anticipated by the OPs who were not well qualified and skilled for the treatment given by them. 17. Secondly the OPs administered labour inducing drug Pitocin containing the dangerous drug Oxytocin in high dose. This drug is always administered gradually because it has Oxytocin. So it was again medical negligence in administering drug which had such a risk that its high dose can cause excessive bleeding. Though the child was delivered after one hour of the arrival of the deceased at the clinic but this drug was induced within five minutes and as a result the deceased suffered excessive bleeding which ultimately resulted in her death in the clinic of the OP itself. 18. When a woman with overdue pregnancy goes into precipitate labour it takes some time for delivery to take place and therefore to say that everything became complicated and unanticipated within five minutes i.e. taking the deceased to the examination room, putting her on the examination table and then examining her and her going into precipitate labour is not correct. The deceased did not go into precipitate labour all of a sudden. She went into precipitate labour after administering the labour inducing drug Oxytocin in a high dose that also in one go. Such a treatment is highly unprofessional and negligent. The State Commission, therefore, directed the Appellants to pay a lump-sum compensation of Rs.1,00,000/- for limited deficiency in administering irrational and high dose of medicine to precipitate labour and without adequate arrangements for the treatment of the Patient. 5. Being aggrieved by the above order, the present first appeal has been filed. 6. Appellant No.2 (in person) and Counsel for Respondents made oral submissions. 7. Appellant No.2 while admitting that the Patient had come to her clinic after the due date of delivery stated that she had no knowledge about her past medical history since Patient had not brought any papers pertaining to any ante-natal check-ups. She was 38 years old and this was her fourth pregnancy. She reiterated that precipitate labour followed within minutes of her examining the Patient and she delivered a male child thereafter. The placenta and membrane was also completely delivered by 3.10 p.m. i.e. quite soon after the delivery but since the uterus was not contracting and the Patient was hemorrhaging, which did not get controlled despite the abdominal massage of the uterus, Patient was given injection Methergin to initiate contraction of the uterus. Since this also did not help, 5% Pitocin drip C-20 Units was administered in the prescribed manner and not as contended by the Respondents/ Complainants in one dose prior to the delivery. These facts are clearly indicated in the referral letter that she had prepared for referring the Patient to Dr. B.L. Kapoor Hospital. Appellant No.2 also brought to our attention medical literature on the subject which had also been filed before the State Commission to support her contention that the treatment undertaken by her was standard case management to deal with Post-Partum Hemorrhage (PPH). This literature included Mudaliar and Menon linical ObstetricsNinth Edition, confirming the above standard treatment. Appellant No.2 further reiterated that although arrangements had been made to shift the Patient to Dr. B.L. Kapoor Hospital, her husband and relatives did not heed this advice and took her home where she expired. Under these circumstances, there was no medical negligence on her part and as a professional midwife she followed the standard case management and did her best to medically treat the unexpected PPH that occurred. 8. Learned Counsel for the Respondents/Complainants on the other hand stated that Appellant No.2 contention that Pitocin was given to check the PPH and not to precipitate labour is not correct. The evidence relied on by the Appellant, namely, the letter written to Dr. B.L. Kapoor Hospital stating that the Pitocin drip was started after the delivery cannot be relied on since it is a fabricated document subsequently prepared as an alibi to counter the allegation of medical negligence because in this letter it is stated that the delivery and the treatment was done on 19.09.1995 whereas the actual date of the delivery and the death was admittedly 17.09.1995 itself. Patient was cremated on 18.09.1995. Therefore, Appellant own defence instead of helping her in fact indicts by confirming that she had produced false evidence to hide her own negligence. Clearly, she has not been able to produce any credible evidence to prove that she was not guilty of medical negligence. 10. We have heard Appellant No.2 in person and Counsel for Respondents/Complainants and have also gone through the evidence on record, including the medical literature on the subject. Patient visit to Appellant No.1/Clinic with an overdue pregnancy is not in dispute. It is further admitted that she delivered a male child in that clinic and expired the same day. Appellant No.2 has vehemently denied Respondents/Complainantscontention that the Patient died because Appellant No.2, who is a midwife, administered a high dose of Oxytocin not gradually as is strongly recommended but at one go to induce labour and this resulted in the rupture of the uterus followed by uncontrolled hemorrhaging and death. After going through the evidence and records, we find substance in this contention of the Respondents/Complainants which was also the finding of the State Commission because it is not possible to place any reliance on the document produced by the Appellant indicating that Oxytocin was administered following the delivery and to check PPH and not to precipitate the delivery. This is because in two places it is clearly stated in this document in Appellant No.2 own handwriting that the delivery and hemorrhaging took place in her clinic on 19.09.1995, which is factually incorrect casting serious doubts in the veracity of this document and the bonafides of the Appellant. Appellant has sought to explain this by saying that the date was wrongly written by her because of a bonafide error. However, we note that she has not mentioned this significant rrorin any of the documents filed by her before the State Commission, including her written submissions nor has she filed any affidavit stating that the date was wrongly written by her through oversight/error. Appellant No.2 has, thus, not been able to produce any credible evidence to counter the complaint of medical negligence on her part. 11. We have also perused the medical literature on the potential risks of administering Oxytocin. No doubt it is the drug of choice for making the uterus contract to induce and accelerate labour and it is also the treatment to stop PPH bleeding. However, it is also well documented that there are major risks if this drug is administered too fast to a patient of high parity and late in labour since it could cause the uterus to rupture*. (*Source : Article by Dr. C.M. Zelop, Dr. T.D. Shipp, Dr. A. Kohen et all from the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, USA) In other words, in a pregnant patient Oxytocin is required to be given by intravenous infusion starting with small doses to be administered gradually. Looking at the present case and in the absence of any credible evidence produced by Appellant No.2 to support her contention, we are of the view that the Patient who was at risk being both high parity and late in labour was given Oxytocin prior to the delivery to precipitate labour undoubtedly in an irrational manner and not in small and gradual doses as per standard medical procedure, which caused her uterus to rupture leading to hemorrhaging and death. 12. In view of these facts, we agree with the State Commission that the treatment in this case was ighly unprofessional and negligent We, therefore, uphold the order of the State Commission and dismiss the present First Appeal. Appellants are directed to pay a sum of Rs.1,00,000/- as compensation to the Respondents/Complainants within one month, failing which it will carry interest @ 9% per annum from the date of this order till the date of payment. No costs.