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.”