Andhra Pradesh

StateCommission

CC/26/08

Mr. K. Surender Reddu and others - Complainant(s)

Versus

Ms Gemini Nursing Home - Opp.Party(s)

Ms S. Surya Prakasa Rao

30 Aug 2011

ORDER

 
Complaint Case No. CC/26/08
 
1. Mr. K. Surender Reddu and others
19-1-108/1, Markandeya Colony, Godavarikhani, Karimnagar Dist.
Karimnagar
Andhra Pradesh
...........Complainant(s)
Versus
1. Ms Gemini Nursing Home
Near Rajesh Theatre, Markandeya Colony, Godavarikhani, Karimnagar Dist.
Karimnagar
Andhra Pradesh
............Opp.Party(s)
 
BEFORE: 
 HONABLE MRS. M.SHREESHA PRESIDING MEMBER
 
PRESENT:
 
ORDER

 

 

 

 

BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION

AT  HYDERABAD.

 

C.C. 26  of  2008

Between:

 

1. K. Surender Reddy

S/o. K. Thirupathi Reddy

 

2. K. Mahitha Reddy

Minor Rep. by her  father

K. Surender Reddy

Both R/o. 19-1-108/1

Markendeya Colony

Godhavarikhani,

Karimnagar Dist.                                       ***                           Complainants

 

                                                                   And

1) Gemini Nursing Home

Rep. by its authorised representative

Near Rajesh Theatre,

Markendeya Colony

Godhavarikhani,

Karimnagar Dist.                    

 

2)  Smt. Dr. Vanaja Rapole

Obstetrician & Gynaecologist

C/o Gemini Nursing Home

Near Rajesh Theatre,

Markendeya Colony

Godhavarikhani,

Karimnagar Dist.                                        ***               Opposite Parties.  

 

Counsel for the Complainant:                    M/s. S. Surya Prakash Rao

Counsel for the  Ops.                                  M/s.  V. Sankara Rao  

 

                    

CORAM:

 

HON’BLE SRI JUSTICE D.APPA RAO, PRESIDENT.

                                             SRI R. L. NARASIMHA RAO, MEMBER

&

                                            SRI T. ASHOK KUMAR, MEMBER

         

 

TUESDAY, THIS THE THIRTIETH DAY OF AUGUST TWO THOUSAND ELEVEN

 

 

ORAL ORDER:  (Per Hon’ble Sri Justice D.Appa Rao, President.)

 

***

 

 

1)                This is a complaint filed seeking Rs.  22 lakhs  against the  opposite party hospital and the Gynecologist  alleging medical negligence. 

 

 

 

2)                The case of the complainants in brief is that complainant No. 1 is the husband and complainant No. 2 is the minor daughter of  Smt. Sujatha.   When Sujatha became pregnant she was attending  Op1 nursing  home for regular check up.   Op2 gynecologist   had been administering the required treatment as an out-patient.    On the advise of Op2 she joined as an in-patient  on  22. 11. 2006.   While so on 29.11.2006  her health  condition became critical.  On that  they rushed to Op2.  Though she came and informed that she could treat her, despite their request to refer to any other hospital  as  there was no  necessary infrastructure in the hospital,  however, she did not do so.   All the while they were giving impression that  they would treat Sujatha and declined to show her and suddenly declared that she died at 8.30 p.m.  In fact  they came to learn that  she died  at 4.30  p.m. itself.    On that they gave a complaint on which the police registered it  as a case u/s 304-A  of IPC.    The post-mortem examination was still pending.   There was gross negligence  on the part of Op1 hospital as well as Op2 while conducting the delivery.   They have cheated them by disclosing that  she died at 8.30 p.m. though she died at  4.30 p.m.   She was well educated  and was working as Junior Lecturer drawing a salary of Rs. 5,000/-.  Due to her sudden death  they lost an earning member.   Complainant No. 1 had lost conjugal life while complainant No. 2 lost her mother.   They have spent Rs. 20,000/- towards treatment.  In all they claimed Rs. 22 lakhs towards compensation. 

 

3)                 Opposite Parties 1 & 2 resisted the case.   They alleged that there was no negligence  while treating  the patient Smt. Sujatha when she was admitted for delivery.    Op2 is a  qualified Gynecologist and Obstetrician  and underwent  anesthetist training for a period of one year, and has 23 years of experience in the field.    Due to the treatment given by her she regularly came to the hospital for  anti-natal check up.   There was a long gap from first pregnancy to second pregnancy.   Her health condition was not deteriorated 

 

 

nor they requested  the  patient be referred to some  other  hospital for treatment.    On  29.11.2006  at about  5.00 p.m.   the patient came to delivery room from the ward without anybody’s assistance.   Her mother was also present  near the delivery room.    There after at around  6.00 p.m.  the patient complained  chills and  had vomitings,   and at about 6.45 p.m. she threw a fit  and become unconscious.    Immediately  Dr. Srinivas, Chest Physician  was called.   She also called  Dr. Sheshu Kumar, Anesthetist.  Resuscitation was carried however the patient was declared dead at  7.30 p.m.   A mob of 200 people attacked the doctors and nursing home, and magnified  the situation by calling  up the press  and also a complaint to the police.   They snatched away the entire record  including the case sheet.    They demanded Rs. 10 lakhs.   Uncle of the patient is a journalist  in Andhra Jyothi  who magnified the situation.   The complainant is a driver who left his first wife and married the deceased.   All this shows his conduct.   There was no negligence  on her part in treating the patient.    Husband of  Op2 gave police complaint stating that main case sheet  was snatched away by the complainant  which is required in order to explain  and to show as to what exactly happened in the operation theatre.    Final report given by A.P. Vaidya Vidhana Parishad  shows that she died due to ‘Cardio respiratory arrest due to disseminated intravascular coagulation leading to hemorrhage, secondary to amniotic fluid embolism.”   Cardiac arrest  can happen at any time of the delivery so also intravascular coagulation leading to hemorrhage, and amniotic fluid embolism.   It is a rare obstetrical emergency, and unpredictable.   After securing documents from the authorities they would give reply.   They put in all efforts to save the deceased, however they went in vain.  There was no negligence on her part.   It might be the deceased was working as Junior Lecturer, however, she was not aware of  her salary etc.   She had only received Rs. 120/- towards consultation fee  @ Rs. 30/- in four spells.     In fact the complainant had damaged the hospital.    She was explained before giving treatment.  Therefore they prayed for dismissal of the complaint with costs. 

 

4)                The complainants in proof of  their  case filed  the affidavit evidence  of first complainant and got Exs. A1 to A25 marked.  Refuting their evidence  the opposite parties filed their  affidavit evidence, and did not file any documents. 

 

5)                The points that arise for consideration are :

 

                               I.      Whether there was any negligence on the part of Op2  while conducting delivery. 

                             II.      Whether death of the deceased was due to  negligence of Op2?

                          III.      Whether the complainants are entitled to any compensation?

 

6)                It is an undisputed fact that the complainant’s wife Smt. J. Saradha  aged about 24 years  admitted in the Op1 hospital on 22.11.2006  for delivery wherein  Op2 a professional  Obstetrician and Gynaecologist  was looking after the gynaecology  section.   It is also not in dispute that on 29.11.2006  she was taken to delivery ward.    According to Op2  at about 6.00 p.m. she complained chills  and  had vomitings,  and at about 6.45 p.m. she threw a fit  and became unconscious.    It is also not in dispute that  she died due to ‘cardio respiratory arrest due to disseminated intravascular coagulation leading to haemorrhage, secondary to amniotic fluid embolism”  vide final report given by  A.P. Vaidya Vidhana Parishad.  While the complainant alleges that said complication has arisen  due to the fact that the doctor did not attend to her nor taken  minimum precautions  when she was taken to delivery room, Op2 doctor alleged that she was very much present.  However suddenly the above complications were occurred.   She in fact took the assistance of  Dr. Srinivas, Chest Physician who in turn called  Dr. Sheshu  Kumar, Anaesthetist.  Recession was carried out,  however  she died at about  7.30 p.m.

 

 

 

 

 

7)                Op2 doctor complains that the moment she was declared dead the complainant gathered about 200 people  attacked the staff and doctors  in the nursing home, equally the press and the police.   They snatched away the case sheet and other record of the patient.  They made dharna demanding Rs. 10 lakhs  which she did not agree.   On the complaint police also registered a case u/s  304A of IPC.    Op2 Gynaecologist  reiterated  the above facts by stating  ‘cardio respiratory arrest due to disseminated intravascular coagulation leading to haemorrhage, secondary to amniotic fluid embolism”  can happen any moment at the time of delivery.  Equally disseminated intravascular coagulation  leading to haemorrhage, secondary to amniotic fluid embolism   is a rare obstetrical emergency and unpredictable.    The complainant himself filed a Photostat copy of the case sheet maintained by the hospital marked as  Ex. A1.   Various clinical reports   Exs. A6 to A16 including  Sonography test  were filed.    Op2  asserted  that she herself had  recorded each and every entry  in the case sheet about the treatment given, and the medicines administered.  The complainant could not find out nor suggested any fault  in the line of treatment given by Op2.    Equally the evidence of Op2  was not in any way contradicted by adducing evidence of any doctor or an expert in the field.  

 

8)                It is not in dispute that the complainant has a daughter aged about 7 years.   Op2 doctor stated that  in view of the gap between the first pregnancy and the second pregnancy she was prone to  these complications.     Op2  had complained that case sheet was taken away  by the complainant.   Curiously  he filed the case sheet.  It is not in dispute that the police after registering a case against  Op2 gynaecologist recorded the statements of some of the witnesses evidenced under Exs. A17 to A21 and inquest report Ex. A16  obviously due to law and order problem  created on that day.   The police not only registered a case but also investigated the matter.  However, it is not known as to the conclusions in the  final report.    The complainant did not choose to file the final report of the police.    The very complainant  admitted in his affidavit evidence at para-7 stating “  I along with my relatives have also requested the Station House Officer, Godavarikhani  to video record  during the post-mortem of  Mrs. Sujatha, so that there would not be  any scope for manipulation and the true facts will come out.”  The complainant did not choose to summon the video that said to have been recorded at the time of post-mortem examination.    The Civil Assistant Surgeon, Government Area Hospital however conducted the post-mortem examination opined that the death was due to  ‘cardio respiratory arrest due to disseminated intravascular coagulation leading to haemorrhage, secondary to amniotic fluid embolism”    There  is no mention nor evidence that  these complications were resulted  in doctors not attending  on the patient.   

 

9)                In the medical literature excerpted from  Wikipedia  it was mentioned :

Amniotic fluid embolism (AFE) is a rare and incompletely  understood  emergency in which, fetal cells, hair, or other debris enters the mother's blood stream via thebed of the uterus and triggers an allergic reaction. This reaction then results in cardiorespiratory (heart and lung) collapse and 

once the fluid and fetal cells enter the maternal pulmonary circulation in general terms there will be profound respiratory failure with deepand cardiovascularfollowed byand profound

First phase

The patient experiences acute shortness of breath and. This rapidly progresses toas the chambers of the heart fail to dilate and there is a reduction of oxygen to the heart and lungs. Not long after this stage the patient will lapse into a. While previously believed to have a maternal mortality rate of 60-80%, more recently it has been reported at 26.4%.

Second phase

Although many women do not survive beyond the first stage, about 40 percent of the initial survivors will pass onto the second phase. This is known as thephase and may be accompanied by severe shivering, coughing, vomiting, and the sensation of a bad taste in the mouth. This is also accompanied by excessive bleeding as the blood loses its ability to clot. Collapse of the cardiovascular system leads to fetal distress and death unless the child is delivered swiftly.

 

 

 

 

Causes:

 

It is mostly agreed that this condition results from amniotic fluid entering the uterine veins and in order for this to occur there are three prerequisites:

§                    Ruptured membranes (a term used to define the rupture of    

§                    the

§                    Ruptured uterine orveins

§                    A pressure gradient from uterus to vein

Although exposure to fetal tissue is common and thus finding fetal tissue within the maternal circulation is not significant, in a small percentage of women this exposure leads to a complex chain of events resulting in collapse and death.

 

Disseminated intravascular coagulation (DIC) is a rare, life-threatening condition that prevents a person's blood from clotting normally. It may cause excessive clotting (thrombosis) or bleeding (hemorrhage) throughout the body and lead to shock, organ failure, and death.

 

In DIC, the body's natural ability to regulateclotting does not function properly. This causes the blood's clotting cells  (platelets)  to clump together and clog small blood vessels throughout the body. This excessive clotting damages organs, destroys blood cells, and depletes the supply of platelets and other clotting factors so that the blood is no longer able to clot normally. This often causes widespread bleeding, both internally and externally.

 

DIC is a very complex condition that can be hard to diagnose. There is no single test that is used to diagnose DIC. In some cases, several different tests given over a period of time may be needed for an accurate diagnosis.

 

In the light of above, and when there is no contrary evidence suggesting at least from the case sheet maintained by the doctor marked as Ex. A1 that all this was outcome of the negligence.  It cannot be said that there was negligence on the part of Op2 in attending on the deceased at the time of delivery.  The complainant ought to have examined any  of the doctors  to contradict the answers given by Op2  on  the interrogatories served by the complainant on her. 

 

 

 

 

 

 

10)              It is not in dispute that  Op2 is a competent  Obstetrician & Gynaecologist and authorised to treat these cases.  

 

The basic principle relating to medical negligence is known as the BOLAM Rule. This was laid down in the judgment of Justice McNair in Bolam vs. Friern Hospital Management Committee (1957) 1 WLR 582 as follows :

 

“Where you get a situation which involves the use of some special skill or competence, then the test as to whether there has been negligence or not is not the test of the man on the top of a Clapham omnibus, because he has not got this special skill. The test is the standard of the ordinary skilled man exercising and professing to have that special skill. A man need not possess the highest expert skill….. It is well-established law that it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular art.”

 

Bolam’s test has been approved by the Supreme Court in Jacob Mathew’s case.

 

 

In Halsbury’s Laws of England the degree of skill and care required by a medical practitioner is stated as follows :

“The practitioner must bring to his task a reasonable degree of skill

and knowledge, and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence, judged in the light of the particular circumstances of each case, is what the law requires, and a person is not liable in negligence because someone else of greater skill and knowledge would have prescribed different treatment or operated in a different way; nor is he guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art, even though a body of adverse opinion also existed among medical men. Deviation from normal practice is not necessarily evidence of negligence. To establish liability on that basis it must be shown (1) that there is a usual and normal practice; (2) that the defendant has not adopted it; and (3) that the course in fact adopted is one no professional man of ordinary skill would have taken had he been acting with ordinary care.”

 

No one can deduce the factum of negligence from the fact of death of the patient.   There should be either ex-facie evidence from which one can  gather that  there was negligence or from the evidence of an expert one can conclude that there was negligent treatment  or wrong treatment.  It cannot be readily  inferred  that there was negligence  on the part of  Op2  while  conducting delivery without any evidence.   We do not see any merits in the complaint.

 

 

 

 

11)              In the result the complaint is dismissed. No costs.

 

 

1)      _______________________________

PRESIDENT                 

 

 

 

2)      ________________________________

 MEMBER           

 

 

         

3)      ________________________________

 MEMBER           

 

                                     

APPENDIX OF EVIDENCE

 

Witnesses examined for Complainant:        None

 

Witness examined for opposite parties:      None

 

 

Documents marked for complainant:

Ex  A-1           Case sheet dated : 22.11.2006 for opp.party no.1 hospital

Ex A-2                        Case sheet dated : 27.11.2006 of opposite party no.1 hospital

Ex A-3                        Provisional Certificate vide no.028016 dated : 25.3.2004 issued by                                                 Kakatiya University, Warangal in the name of Smt. V. Sujatha                                                        for MA (Economics)

Ex A-4                        Report dated : 08-05-2006 of M/s. Gemini Clinical Laboratory.

Ex A-5                        Report dated : 26.5.2006  of M/s. Gemini Clinical Laboratory with                                                 Scanning picture.

Ex A-6                        Report dated : 19.4.2006 of pposite party no.1 on the letter head of                                                            opposite party no.2

Ex A-7                        Report dated ; 15.4.2006 of M/s. Gemini Clinical Laboratory

Ex A-8                        Report dated 15.4.2006 of opposite party no.1 on the letter head                                                     of opposite party no.2.

 

Ex A-9                        Report dated 22-06-2006 of M/s. Gemini Clinical Laboratory with                                                  Scanning picture.

Ex A-10          Report dated : 19-10-2006 of  opposite party no.1 on the letter head                                               of opposite party no.2

Ex A-11          Report dated : 23.09-2006 of M/s. Gemini Clinical Laboratory                                                        with scanning picture.

Ex A-12          Report dated : 25-07-2006 of opposite party no. 1 on the letter head of            

                       opposite party no.2

 

 

 

 

 

 

Ex A-13          Report dated : 25.7.2006 of opposite party no.1 on the letter head of                                              opposite party no.2

Ex A-14          Report dated : 01.11.2006 of opposite party no.1 on the letter head of                                            opposite party no.2

Ex A-15          FIR no.414 of 2006 issued by SHO, Ps Godavarikani.

Ex A-16          Post mortem vide order no.635 (1) in Crime No.414 of 2006

Ex A-17          Case Diary Part II in FIR No. 414 of 2006 dated : 30-11-2006                                                        statement of V.Sathish Babu recorded by SHO , PS Godavarikhani.

Ex A-18          Case Diary Part II in FIR No. 414 of 2006 dated : 30-11-2006 statement                                        of V. Manemma recorded by SHO, PS Godhavarikani.

Ex A-19          Case Diary Part II in FIR No. 414 of 2006 dated : 30-11-2006 statement                                        of complainant no.1 by SHO, PS Godhavarikani.

Ex A-20          Case Diary Part II in FIR No. 414 of 2006 dated : 30-11-2006 statement of                                   T. Shankar by SHO, PS Godhavarikani.

Ex A-21          Case Diry Part II in FIR No. 414 of 20-06 dated : 30-11-2006 statement of                                    A. Malathi by SHO, PS Godavarikani.

Ex A-22          Receipts dated : 22/11, 26/11, 29/11, 22-11-2006 , 26-11-2006 &

29-11-2006.

Ex -23             Publication in Andhra Jyothi, dated : 29-11-2006.

Ex A-24          Publication in Eenadu dated : 30-11-2006

Ex A-25          Publiction in Vaartha dated : 30-11-2006.

 

 

Documents marked for Opposite Parties :                     Nil

 

 

 

1)      _______________________________

PRESIDENT                 

 

 

 

2)      ________________________________

 MEMBER           

 

 

         

3)      ________________________________

 MEMBER           

 

                                                                                      30/08/2011

 

*pnr

 

 

 

 

 

 

 

 

 

 

“UP LOAD – O.K.”

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 
[HONABLE MRS. M.SHREESHA]
PRESIDING MEMBER

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