By  Smt.Padmini Sudheesh, President :  

          The case of complainant is that on 18/8/06 the complainant was admitted at 1^st respondent hospital for delivery under the treatment of 2^nd respondent.  On 19/8/06 the delivery was taken place by way of caesarian.  The sterilization was also done along with caesarian.  There was no complication to complainant till the surgery.  After the same it is noticed that urine was leaking without any control.  It was intimated to 2^nd respondent and told that it will be cured.  Believing this the complainant got discharged from the hospital.  Even after the discharge this complication was continued and the complainant was admitted in a private hospital in Thrissur.  It was intimated that 2^nd respondent  had committed  surgery negligently and the bladder was got injured and sutured the  injury negligently.  So this had happened.  There was negligence on the part of 2^nd respondent.  So a lawyer notice was issued   to respondent and reply  sent by respondent also.  Hence the complaint.

          2. The averments in the version of 2^nd respondent in brief are that there is no negligent act or deficiency in service as alleged by complainant.  This respondent is a  consultant  gynaecologist working in 1^st respondent hospital.  The complainant consulted this respondent on 18/8/06 at 10pm with the complaint of amenorrhoea of 9 months duration and  leaking per vagina.  Her previous pregnancy was also managed by this respondent and she had undergone a caesarian operation to deliver the baby.  After  giving enema the patient was kept in labour  room. She was getting mild contraction.  On 19/8/06, the next day at around 8am artificial rupture of the  membrane was done by 2^nd respondent  following which clear liquor drained out.  Since the patient was  progressing well after A.R.M, routine 1^st stage care was given.  At around 11.15am the patient was getting moderate uterine contractions and cervix was four fingers dilated.  Vertex  was -1 station.  Since the foetus was not descending further even with good  uterine contractions it was decided to do an LSCS.  Since the couple  had completed their family they had requested for  sterilization.  Hence LSCS with sterilization was done on 19/8/06 and  a male baby   weighing 3kg was delivered at 12.39pm.  During surgery it was found that there was lot of adhesions between the bladder and uterus and surrounding peritoneum resulting in  urinary bladder being pulled up and morbidly adherent to the lower segment of the uterus.  Such adhesions are  quite common  in any patient who had a history of undergoing a caesarian  section or had a history of pelvic infection.  During the  procedure of caesarian section the adhesions had to be  separated, resulting in brisk bleeding from several sites.  While separating the bladder peritoneum, bladder got injured over the posterior wall.  General surgeon Dr.Kuriakose Mampallil  of  1^st respondent hospital was called for assistance.  The bladder repair was done and  abdomen closed with  foley’s catheter  for bladder drainage.  To ensure  adequate haemostasis many ligatures and  electro cautery  had to be used.  The patient was then shifted to the post operative ward.  She was given  medicines  and antibiotics to prevent infection.  Since the blood lost was more than normal  two units of compatible blood were given.  In the post operative ward  urine was draining well but it was  mixed with blood more than normal.  The consultant urologist Dr.P.G.Antony  from Trichur was  called  who did  reexploration.  Blood clots  in the bladder were removed.  There was bleeding from the   sutured injury  site at the posterior bladder wall.  Hence  re-sutured was done and bleeding controlled.  The complainant responded  well post operatively.  Two more units of blood transfusion were given on  23/8/06 and 24/8/06.  Output  was adequate and clear urine was draining.  Catheters were removed after consulting with Dr.P.G.Antony following which patient was passing urine normally.  There was no leakage seen.  Hence she was discharged on 31/8/06.  When she came for  postnatal checkup speculum examination  showed a doubtful leak.  Possibility of  vesico vaginal fistula  was suspected.  She was then referred to  urologist Dr.P.G.Antony who advised admission for evaluation.  She promised to come after two days but did not come.  The other averments in the complaint are denied.  This respondent is  a paid employee of 1^st respondent hospital  and the principle of vicarious liability is applicable in this case.  This respondent is a gynecologist having 30 years of experience.  This respondent  is not liable to pay any amount for compensation. Hence dismiss.

          3. The 1^st respondent remained exparte.

          4. Points for consideration are that :

1) Whether there was any negligent act done by respondents ?

2)  If so reliefs and costs ?

          5. Evidence consists of oral testimonies of PW1, PW2 and RW1 to RW3, Exhibits P1 to P7 series and Exhibit R1 series.

          6. The complaint is filed to get compensation by alleging medical negligent act on the part of respondents.  It is the case that on 18/8/06 the complainant was admitted at 1^st respondent hospital for her second delivery and the delivery was taken place on the next day by way of caesarian.  Sterilization of pregnancy was also done by 2^nd respondent along with caesarian.  According to complainant after the surgery it is noticed leaking of urine and it was informed to respondents and 2^nd respondent advised  it will be cured  without a separate treatment.  But it was not cured and complainant was admitted in  another private hospital in Thrissur.  It is the case of complainant that  it was told by the doctors at that private hospital that the  leaking of urine is because of cut injury caused to bladder while  committing surgery by 2nd respondent doctor.  It is the definite case of complainant that  2nd respondent doctor had done the surgery very negligently and injury caused to the bladder of complainant.

          7. The 2nd respondent doctor filed a detailed version by submitting the procedure done by her, general surgeon and urologist.  According to  them during surgery it was found that there was lot of adhesions between the bladder and uterus and surrounding peritoneum resulting in  urinary bladder being pulled up and morbidly adherent to the lower segment of the uterus. During the  procedure of caesarian section the adhesions had to be  separated, resulting in brisk bleeding from several sites.  While separating the bladder peritoneum, bladder got injured over the posterior wall.  The 2nd respondent doctor also stated in the version that then the general surgeon was called for assistance and bladder repair was done and abdomen closed.  Even if she was  shifted to post operative ward it was found that urine was draining well.  But was mixed with blood which was more than normal.  So  consultant urologist Dr.P.G.Anotny was called and he conducted a reexploration. According to 2nd respondent  doctor after the treatment of Dr.P.G.Antony bleeding was under control.  Hence she was discharged  on 31/8/06.  According to complainant leakage of urine was caused only because of the negligent act on the part of 2nd respondent doctor.  She would say that 2nd respondent doctor conducted  surgery negligently and injury caused to bladder and 2^nd respondent failed to suture it properly and so bleeding and leaking of urine were caused.  She is examined as PW1 and according to her 2nd respondent doctor told her that leaking of urine will be  all right slowly.  Since she  has no medical knowledge  she has answered the questions about these aspects as she does not know  She categorically deposed that at  the time of  discharge from 1st respondent hospital on 31/8/06 there was  urine leakage.  According to her the urine leakage was not cured by 2nd respondent doctor or  RW2 or RW3.  Only after the treatment  at Daya hospital in Thrissur it was cured. 

          8. Exhibit P2 is the discharge summary from Daya hospital by which it can be seen that the diagnosis as Vesico Vaginal Fistula.  As per the procedure it can be seen that bladder  opened and procedure was done.  It can be seen from Exhibit P2 very clearly.  Dr.A.C.Velayudhan is examined as PW2 and he admitted that Exhibit P3 is the certificate issued by him.  Accordingly surgery was done on 18/10/06 and discharged on 3/11/06.  The procedure is V.V.F. repair. According to him if an injury caused to urinary bladder and is not sutured properly with care there is chance of leaking. He definitely deposed that the leaking was from the  suture site.  During cross examination it is admitted by PW2 that only after pulling out the bladder  caesarian  can be done and at that time there is possibility for causing injury.  He would further say that even if repaired by urologist there is possibility of leakage.  But the doctor who is conducting caesarian should found it and repair is the standard procedure.  He deposed that standard procedure had done in this case also.

          9. It is the definite case of PW1 that there was negligent act on the part of RW1 in conducting the surgery and so injury was caused to bladder and also negligence  and carelessness on the part of doctor to suture the same properly.  According to PW2 finding out the injury and repairing the same is standard procedure.

          10.There are two expert witnesses examined on the part of 2^nd respondent and 2nd respondent is examined as RW1 also.  According to her she knows the adhesions of uterus and urinary bladder.  But this  incident is rare  is the statement of RW1 in the box.  She also stated that leaking of bladder will occur in case of repeated caesarian.  The case of PW1 of happening of the cut injury and leaking are denied by RW1.  She also denied the reason of leakage due to improper suturing.  According to her in this case she had realized  the leaking at once and the general surgeon closed it immediately.  According to PW2 in this  case Dr.P.G.Antony, RW3 had re-explored the injury and sutured. But RW1 deposed that general surgeon closed the same.  If there was proper closure there is no need of re-exploration by RW3 doctor P.G.Antony.  In the version RW1 stated  the procedure done by Dr.P.G.Antony.  Then it is clear that there was improper handling on the part of RW1 and the general surgeon in closing the wound.  It is the negligence on the part of doctors.

          11.According to RW1 at the time of discharge PW1 did not have complaint about leaking. But according to PW1 at the time of discharge also she has the complaint of leaking and RW1 told that it will be cured gradually.  According to RW1 leaking will also happen due to delayed necrosis.  But she has no such case in the version.  In Exhibit R1 it has noted  the calling of general surgeon and repairing of bladder.  Then it was the duty of RW1 to apply the standard procedure as stated by RW3.  Dr.P.G.Antony is examined as RW3 and he deposed that as per the request of RW1 he had treated the complainant  emergently.  He was called because  through the catheter which was put for urine passage excessive bleeding was found and the doctor wanted him to consult the patient.  The procedure done by him is stated in Exhibit R1 and the relevant portion marked as Exhibit R1(a).  It is seen that he had committed re-exploration and controlled bleeding.  According to him if injury was caused to bladder the repair of the same by  urologist or surgeon is the standard procedure.  In this case surgeon repaired and later bleeding was increased and he was called.  So he conducted reexploration and closed the wound.  These statements of RW3 would lead that there was negligence on the part of RW1 and RW2 in conducting the procedure.   During cross examination he has deposed  the possibility of leaking  if entire injury is not sutured and if the suturing was improper. 

          12.According to complainant  for further treatment she was admitted in Daya hospital, Thrissur and Vesico Vaginal Fistula repair was done.  It was done on 18/10/06 wherein the caesarian section was done on 19/8/06.  According to RW1 the leaking after three months is called fistula.  A woman who was delivered a child by way of caesarian and also conducted sterilization surgery had suffered a lot due to the acts of RW1 doctor.  Due to her negligence and also the negligence of RW2 the said woman had undergone another surgery immediately after the  caesarian and sterilization for repairing the bladder.  The condition of the  woman  can be  presumed.  It was a very pathetic condition and she had  to care a baby also.  After two months she was  again undergone the surgery and it can be seen from the records.  All these were because of the  carelessness and negligence  on the part of RW1 doctor in conducting the surgery. There is no doubt about the negligent act committed by respondents. In this case the 1st respondent hospital remained exparte on 4/6/2008.  At this time, no application filed to set aside exparte order and to contest the case as stated by RW1.  The hospital is vicariously  liable to compensate the complainant. 

          13.In the result the complaint is allowed and the 2nd respondent is directed to pay Rs.1,00,000/- (Rupees One lakh only) to the complainant and the 1st respondent is also directed to pay Rs.1,00,000/- (Rupees One lakh only) and both are directed to pay Rs.5,000/- (Rupees Five thousand only) as cost within a month from the date of receipt of copy of this order.

          Dictated to the Confidential Assistant, transcribed by her, corrected by me and pronounced in the open Forum this the 15^th    day of  January 2014.