BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION
AT HYDERABAD.
F.A. 879/2008 against C.C. 7/1998, Dist. Forum-I, Hyderabad.
Between:
Darayab Singh, S/o. Jagan Singh
Age: 44 years, Technical Officer
Project Directorate of Poultry
Staff Quarters, Rajendra Nagar
Hyderabad. *** Appellant/
Complainant.
And
1) Medwin Hospital,
Rep. by its Managing Director
Raghava Ratna Towers
Chirag Ali Lane, Hyderabad.
2) Dr. Rooma Sinha
W/o. Sanjay Sinha
Age: 39 years, 405
Tulasi Apartments
8-3-833, Srinagar Colony
Hyderabad. *** Respondents/
O.Ps.
Counsel for the Appellant M/s. A. Anasuya
Counsel for the Respondent: M/s. K. Chaitanya & Associates
CORAM:
HON’BLE SRI JUSTICE D.APPA RAO, PRESIDENT.
&
SRI R. L. NARASIMHA RAO, MEMBER.
MONDAY, THE TWENTY NINETH DAY OF NOVEMBER TWO THOUSAND TEN
ORAL ORDER: (Per Hon’ble Sri Justice D. Appa Rao, President.)
***
1) Appellant is unsuccessful complainant.
2) The case of the complainant in brief is that his wife Smt. Anita Singh gave birth to two children in her parent’s village by normal delivery. She was having good health and no complaints were reported at any time. In 1997 when she conceived again she consulted one of the doctors in Op1 Medwin hospital. She was also going for periodical check ups with Dr. Rooma Sinha, Gynaecologist (Op2) in the said hospital. She advised that his wife should undergo caesarean operation for delivery and advised her to be admitted in Op1 hospital on 18.10.1997. Operation was performed on 19.10.1997 wherein she delivered a female child. On the same day he was informed that her condition became critical and she was kept in Intensive Care Unit (ICU), and no one was permitted to see the patient. Dr. V. Ayyagari, Project Director visited her on 22.10.1997 along with Dr. C. K. Mohan Rao, Mr. K. J. Matthai, Administrative Officer and others. They tried to find out as to the complication that was developed but could not as the opposite parties had rejected to divulge. When he contacted Op2 she informed that her duty was over and the post-operative care would be taken by some other doctor in the ward. His project Medical Officer who has seen the patient opined that she might have developed problems in lungs, heart and also kidney. She was on ventilation with Oxygen mask. He opined that it was due to medical negligence of the doctors at the time of operation. Later he came to learn that no specialist doctor had attended on her. On that he approached the Dean of NIMS and requested her to admit the patient. Despite his requests they did not refer her to NIMS for about 89 days. In fact there was no need for conducting caesarean. Earlier she had delivered two female children by normal delivery. Due to mis-management on the operation table complications were encountered not only by the patient but also by the new born baby. They are harassing him to pay Rs. 4.40 lakhs towards the bill. Alleging deficiency in service on the part of opposite parties he claimed damages and prayed that she be permitted to be shifted her to Medi Citi or Apollo Hospital and permit the specialists to study the case sheet to find out her condition.
3) Op2 resisted the case. Her plea is adopted by Op1 hospital. She alleged that the patient, wife of the complainant came to her for the first time on 29.8.1997 after 31 weeks of pregenancy. Though she asked her to come after two weeks, she came only six weeks there after. The total number of ante-natal check ups should be at least 8- 10 in pregnancy. She was a high risk patient due to multi-gravidity. The likely problem in such patients is their inability to deliver vaginally due to progressive calcium depletion of the pelvic bones. In her first visit she concealed her obstetric history. On her last visit she had divulged that she had three vaginal deliveries of which two female children were alive and one male child died soon after birth due to difficulty in delivery. She came to their hospital on 18.10.1997 at 12.45 p.m. in early labour without her previous record. She was advised to be observed for normal vaginal delivery. After 9 hours of trial of labour she went into deep transverse arrest and foetal distress developed. She and her husband were informed that she had to undergo caesarean section (C.S). The operation was performed after taking their consent. A live female child was born with mild birth anoxia but could be resuscitated immediately to prevent any problem for the new born baby. At the end of surgery it was revealed that the patient was unable to maintain oxygen saturation on spontaneous breathing and possibility of aspiration pneumonities was thought of on the operation table. Immediately treatment was started. However, her Chest X-Ray showed classical Adult Respiratory Distress Syndrome (ARDS). Immediately the treatment was given in consultation with Pulmonologist, Cardiologist, Acute Medical Care Physician in addition to primary consultant. The daily assessment of the condition of the patient was taken and the same was informed to them. Dr. C. K. Mohan Rao, who referred the patient was informed and they had explained in detail as to the treatment given. He thought that post operative care was not adequate. He was hand in glove with the complainant to evade payment of the bill. There was no negligence on their part. The bill for Rs. 4 lakhs was sent to the Project Director and the complaint was a consequent development to evade said bill. Due to ARDS her lungs were not functioning properly and she was given ventilator support by positive and expiratory pressure. Within a few days she became conscious and normal, and the ventilator support was weaned off. At the request of the complainant she was referred to NIMS. By that time, she was conscious, coherent and ambulatory and was able to breathe spontaneously without ventilator support. She was on semi-solid diet. The complainant was making wild allegations in order to evade payment of amounts due to the hospital. Even in the NIMS she was given very same treatment and she was discharged as she was normal since then. She is an experienced Gynaecologist. She had survived without any damage to any of the organs . There was no deficiency in service on their part and therefore they need not pay any compensation and prayed for dismissal of the complaint with costs.
4) The complainant in proof of his case filed his affidavit evidence and examined Dr. C. K. Mohan Rao as PW2, and got Exs. A1 to A4 marked. Refuting his evidence Op2 was examined as RW1 and filed Exs. B1 case sheet maintained by Opposite parties & B2 case sheet maintained by NIMS.
5) The Dist. Forum after considering the evidence placed on record and in the light of evidence by way of case sheets Exs. B1 & B2 and that of RW1 opined that there was no negligence on the part of opposite parties either in conducting the operation or in treating the patient and therefore dismissed the complaint with costs of Rs. 2,000/-each.
6) Aggrieved by the said decision, the complainant preferred the appeal contending that the Dist. Forum did not appreciate either facts or law in correct perspective. It ought to have seen that the patient had developed ARDS while conducting the caesarean operation negligently. RW1’s own evidence reveals that infection was caused to the lungs. At the time of inserting endotracheal tube, ARDS was caused and this itself constitutes negligence and therefore he was entitled to compensation.
7) The points that arise for consideration are:
i. Whether there was any negligence on the part of opposite parties in conducting the operation or in treating the patient?
ii. Whether the complainant is entitled to any compensation?
iii. If so , to what relief?
8) It is an undisputed fact that wife of the complainant Smt. Anita Singh had delivered a baby child when Op2 a Gynaecologist conducted caesarean operation on 18.10.1997 after taking informed consent from her and from her husband. It is not in dispute that she had earlier three vaginal deliveries of which two female children were alive and one male child died soon after birth due to difficulty in delivery. She was classified as high risk patient due to multi-gravidity. The multi-gravidity is a term where a woman had at least five pregnancies and accepted as high risk pregnancy internationally. The likely problem in such patients was their inability to deliver vaginally due to progressive calcium depletion of the pelvic bones. The case sheet Ex. B1 reveals that the child had developed anoxia but could be resuscitated immediately to prevent any problem for the new born baby. The entries at pages 36 to 39 show that she could not maintain oxygen saturation on spontaneous breathing and possibility of aspiration pneumonities was thought of on the operation table. Immediately treatment was given to her. Chest X-Ray revealed classical Adult Respiratory Distress Syndrome (ARDS). Immediately the treatment was given in consultation with Pulmonologist, Cardiologist, Acute Medical Care Physician in addition to primary consultant. We may state that she was constantly monitored by a team of doctors involving Anaesthetist, Pulmonologist, Cardiologist, Acute Medical Care Physician in addition to primary consultant. The complainant attributes on set of ARDS due to lung injury at the time of insertion of endotracheal tube. He also alleges that she had developed Hypoxia due to non-verification of oxygen saturation.
9) RW1 has in detail mentioned as to the procedure she adopted at the time of conducting the operation and various complications that had set in on the operation table which she could manage by administering the medicines etc. The complainant in order to prove that there was negligence on the part of opposite parties examined Dr. C. K. Mohan Rao. He was authorised Medical Officer of Project Directorate on Poultry (ICAR) wherein the complainant is an employee. He referred her to Medwin Hospital for periodical check up and for undergoing caesarean operation.
He stated that “ Dr Rooma Sinha conducted the operation on 18.10.1997 at about 11.00 p.m. under general anaesthesia and reported that a child was delivered safe and that the recovery of the patient from anaesthesia was delayed due to unknown reasons and the patient is shifted to ICU and was put on ventilator. On the request made by the Project Director, I accompanied the Director and we visited the hospital on 22.10.1997 along with Administrative Officer. That was 4th post operative day. According to him “ I came to know from indirect sources that the patient was mismanaged on the operation table by wrong intubations which has resulted in hypotension and hypoxia and later aspiration of the stomach contents into respiratory tract that has produced patchy pneumonitis and various pulmonary and cardiac complications as evidenced by serial X-Ray studies. Even on that day I have seen the patient, she was irritable and violent. We were told that the patient has pulled out the endotracheal tube by herself from the respirator, mostly due to lack of proper care and medical attention that is needed for an unconscious patient.”
He further stated that “ I was told that her condition was stable after self-extubation by the pulmonologist and obstetrician. Her blood pressure was 120/80 mm Hg. HR 86/mt oxygen saturation was well maintained. The patient was conscious and incoherent. Later by evening she developed acute respiratory problem and was incubated again and connected to respirator. Ever since the patient is continuously on respiratory assistance and was unstable.”
He further stated that “before putting the patient on ventilator, the patient should be paralysed so as to accept the flow of oxygen from ventilator. Because of self extubation, without oxygen supply the patient was kept for some time due to which some of the cells in brain might have been damaged. The patient was kept on ventilator for total 89 days in Medwin Hospital but as her condition was critical I advised her husband to consult some other expert in Pulmonology and Cardiology. He informed me that Medwin hospital authorities are not allowing outside doctors. At that stage on 4.1.1998 he again approached me and asked me to give a report for filing it in Dist. Forum. Accordingly I gave my report on that day. Later I was told that she was shifted to NIMS in pursuance of the interim orders passed by the Dist. Forum.”
10) At the time when she was admitted in NIMS the very same opinion finds place in discharge card Ex. B2 maintained by NIMS. From this it is beyond that PW2 did not attend on her while she was taking treatment in opposite parties hospital. What all he stated was that he gathered the inside information, however not corroborated by any other evidence. RW1 swore on oath and denied all these facts and asserted that ARDS would be caused due to variety of reasons. It was treated, and only at the insistence of complainant she was shifted to NIMS. The evidence of PW1 is of general terms. Except repeating what PW2 had stated, he did not contribute anything to prove that there was negligence on the part of RW1. It is not as though she had alone treated the patient. The case record containing 4 volumes exhaustively show the treatment rendered in the hospital. It reveals that besides RW1 a Gynaecologist, Anaesthetist, Pulmonologist, Cardiologist, Acute Medical Care Physician besides primary consultant were monitoring her condition daily. When she was cross-examined she stated that the injury to the lungs could be one of the reasons for ARDS. Undoubtedly RW1 admitted that at the time of inserting endotrecheal tube ARDS might be caused. She also admitted that the condition of the patient was normal prior to the operation. The complainant contends that this constitutes medical negligence and therefore they are liable to compensate. In fact PW2 his own witness has categorically stated that “ On that particular day when I went on 22.10.1997 I noticed that the patient pulled out the tube when I was with the patient and immediately it was put back by the nurse, who was present there.” This admission demolishes the entire case of the complainant. When she herself had taken out the tube, there was every possibility of injury to the lungs, which must have caused ARDS. Therefore we do not see any negligence on the part of RW1 either in conducting the operation or in treating the patient.
11) The learned counsel for the complainant contended that at page -48 of Ex. B1 case record there was a mention that there was lack of oxygen and had Hypoxia. The cardiologist at page 103 has noted that the patient had developed Hypoxia. We may state that immediately after coming to know of that she was put on ventilator and within a few days she became conscious responding to commands, and once her condition was stabilized the ventilator support was weaned off. If really she had injury to the lungs or Hypoxia the doctors at NIMS would not have given a clean chit by discharging her after she was admitted in the hospital. Even at the time when she was discharged from the opposite party hospital there was categorical mention “Present condition: patient conscious, coherent, moving all limbs. Has tracheotomy in situ.”
12) The Dist. Forum referring to text “Caesarean Delivery extract” by “Dilip Kumar Datta” at page 106 noted that the incidence of ARDS has been difficult to establish. In 1997 it was estimated that there were 1,50,000 cases of ARDS annually in US with a mortality of approximately 50 – 60% and that the subject of ARDS, pathogenesis, anaesthesia, 1990 is placed for reference. So also the medical literature on principle of critical care (International Edition) by J.Hall M.D. & Others wherein it is noted that even if the patient has not substantially improved by 10 to 14 days still recovery is possible. Tracheotomy is reasonable for patient comfort and on going ventilator management.”
13) The complainant though examined PW2 however he did not allege that either the operation or the treatment that was given by the Op2 doctor was not in correct lines. He did not state that the line of operation or treatment was either faulty or there was lack of skill or knowledge. When she had developed ARDS on the operation table treatment was given. She was monitored by taking all precautions. There was no rebuttal evidence to show
that either the operation or the treatment given by her was not in correct lines as observed by the Dist. Forum. Ex. B1 case record discloses that the patient was well taken care right from her admission till discharge. Simply because she had developed sudden complication of ARDS RW1 cannot be found fault. As rightly observed by the Dist. Forum the doctors cannot be made liable for mis-chance even for error or judgement. PW1 in fact has admitted that even in NIMS weaning of ventilator was done and gradually the patient was recovered and became normal. Therefore the sudden development of ARDS and Hypoxia could not be attributed to RW1. The patient was kept on ventilator for 89 days in the hospital. She was recovered whatever ailment she suffered from. We are in full agreement with the opinion of the Dist. Forum. We do not see any mis-appreciation of fact or law by the Dist. Forum in this regard. We do not see any merits in the appeal.
14) In the result the appeal is dismissed. No costs.
1) _______________________________
PRESIDENT
2) ________________________________
MEMBER
Dt. 29. 11. 2010
*pnr
“UP LOAD – O.K.”
