Chandigarh

StateCommission

CC/476/2018

Rajveer Singh Meena - Complainant(s)

Versus

Post Graduate Institute of Medical Education & Research - Opp.Party(s)

Bhavnik Mehta, Rohit Samhotra, Jasbir Singh Mohri Adv.

28 Jan 2022

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

 

Complaint case No.	:	476 of 2018
Date of Institution	:	19.12.2018
Date of Decision	:	28.01.2022

 

 

 

 

 

 

1. Rajveer Singh Meena son of Sh.Banai Singh Meena aged 33 years, resident of House No.357, Adarsh Nagar Block B, Naya Gaon, District Mohali, Punjab.
2. Nishika daughter of Rajveer Meena aged 8 years, through her natural guardian, Sh.Rajveer Meena, resident of House No.357, Adarsh Nagar Block B, Naya Gaon, District Mohali, Punjab.
3. Charul daughter of Rajveer Meena aged 3 years, through her natural guardian, Sh.Rajveer Meena, resident of House No.357, Adarsh Nagar Block B, Naya Gaon, District Mohali, Punjab.

 

……Complainants

 

V e r s u s

 

1. Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh through its Director.
2. Dr.Rimpy Singla, Assistant Professor, Department of Gynaecology, Nehru Hospital, Institute of Medical Education & Research, Sector 12, Chandigarh.
3. Dr.Monika Meena, Senior Resident, Department of Gynaecology and Obstetrics, Nehru Hospital, Institute of Medical Education & Research, Sector 12, Chandigarh .
4. Dr.Neethi, Junior Resident, Department of Gynaecology and Obstetrics, Nehru Hospital, Institute of Medical Education & Research, Sector 12, Chandigarh .

…..Opposite parties

 

BEFORE:               JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT.

                             MRS. PADMA PANDEY, MEMBER.

                             MR.RAJESH K. ARYA, MEMBER.

 

Present through Video conferencing

                             Sh.Bhavnik Mehta, Advocate for the complainants.

       Sh.Rajesh Garg, Senior Advocate for the opposite   parties.

 

PER RAJESH K. ARYA, MEMBER

 

                   The facts in brief are that Smt. Rekha Devi (now deceased) was expecting her second child. She was under medical treatment of Department of Gynaecologist and Paediatric Department of Post Graduate Institute of Medical Education & Research (in short the PGI). There was no prior history of any abdominal surgery of TB etc. except the Lower Segment Caesarean Section (LSCS).  She was admitted in the PGI for medical check-up. The consulting doctor sought her consent, as to whether she wants a normal delivery (VBAC) or to repeat caesarean operation. However, she opted for vaginal birth but due to high blood pressure, the doctor planned surgery i.e. Caesarean operation and sought consent to this effect from her on 01.09.2015. It had been specifically pleaded in para nos. 6 to 14 of the earlier consumer complaint no.461 of 2016 as under:-

 

“6.     That thereafter, Smt. Rekha Devi was shifted to the Clean Labour Room Operation Theatre (CLR/OT) where the doctors performed the caesarean surgery on the wife of the complainant and a baby girl weighing 2.42 kgs was delivered by Smt.Rekha Devi on 01.09.2015 at 6.12 PM. Subsequently, after delivery, Smt.Rekha Devi alongwith the new born child was shifted to Private Ward on 02.09.2015 of the hospital where in the evening on 02.09.2015, Smt. Rekha Devi complained of abdomen pain and Dyspnoea i.e. difficult or laboured breathing. Subsequently, her condition worsened and she started vomiting and complained of increased Dyspnoea.

 

7.       That thereafter on 03.09.2015, the BP of the patient Smt.Rekha Devi started falling and she had difficulty in passing stools and was having acute abdominal distension and the ward residents were duly informed and aware about the condition of the patient, however, the consulting doctors respondents No.2 to 4 did not view the acute condition of Smt.Rekha Devi seriously and did not take any remedial measure.

 

8.     That on 04.09.2015, when the condition of patient Smt. Rekha Devi did not improve, and she was having acute Dyspnea and hypotension, and the report showed “Dilated Bowels Loops with Air Fluid Levels” which means that the X-ray showed there was some intestinal problem with the patient. Even after the X-ray report, the doctors respondent No.2 to 4 did not show any urgency in the matter and in a casual and lackluster manner, the Ultrasound (USG) was conducted in the afternoon of 04.09.2015 alongwith other clinical tests which showed that the TLC count of the patient had arisen to 13,300 against the normal range to 4000-11000 indicating infection in the body. The report of the Ultrasound (USG) showed free fluid in the intestines which means that the intestines are perforated and treated (cut) and thereafter, the patient Smt. Rekha Devi was shifted to Septic Labour Room (SLR).

 

9.        That consequently, on 05.09.2015 the doctors on account of clinical test reports and Ultrasound (USG) reports showing presence of puss in Peritonium cavity diagnosed “PYOPERITONIUM” and decided to re-explore/Perform Emergency Laparotomy Surgery on the patient qua which the consent form was also got signed from the complainant-husband of Smt. Rekha Devi on 05.09.2015 which categorically mentioned that there was presence of Pyoperitonium (free fluid in intestine) and the deteriorating condition of the patient.

 

10.      That it is further most pertinent to mention here that the patient Smt. Rekha Devi was again taken on Emergency Operation Theatre on 05.09.2015 for re-exploration/Emergency Laparotomy Surgery which was performed by respondent No.2 Dr. Rimpy alongwith Dr. Pavneet Koli and Dr. P. K. Saha. The area of earlier surgery was again opened up by the surgeons and as per the post operative notes supplied by the respondent No.1 under RTI, there was presence of about 500-600 ml of multiple flakes of PUSS and there was presence of VEGETABLE MATERIAL and it is further mentioned that there was no bowel injury.

 

11.       That it is further pertinent to add here that during the Laparotomy Surgery on 05.09.2015 the wife of the complainant Smt. Rekha Devi went into hypotension with nil urine output resulting into Kidney Failure Diagnosed as Acute Renal Failure and with further complication of Septicaemia (High Grade Fever) and was put on ventilator and shifted to Communicable Disease Ward.

 

12.       That on 06.09.2015, when the condition of the wife of the complainant Smt. Rekha Devi who was on ventilator and was diagnosed with Acute Renal Failure after Post Exploratory laparotomy Surgery with Pyoperiotonium was deteriorating, the consulting/ operating surgeons including respondent No.2 & 3 planned  a HEAMODIALYSIS on the patient on account of nil urine output and the patient having gone in Acute Renal Failure condition of the patient kept on deteriorating and ultimately at about 3:15 PM on 06.09.2015 the wife of the complainant Smt. Rekha Devi died on account of Septic Shock/Acute Renal Failure with Antecedent cause of Puerperial Sepsis. The complete medical case file of the deceased wife of complainant Smt. Rekha Devi (CR No.201400003601 and admission No.2015057286) as received by the complainant under RTI is appended as ANNEXURE C-4. The medical certificate of cause of death as issued by respondent PGIMER, Sector 12, Chandigarh alongwith death certificate issued by Department of Health Services UT Chandigarh is appended as ANNEXURE C-5.

 

13.       That after the death of his wife Smt. Rekha Devi, the complainant cleared all the pending dues/bills of respondent PGIMER pertaining to the treatment and surgery and thereafter, the complainant was released the dead body of his wife from the mortuary of the PGIMER. One such final adjustment bill-cum-receipt issued by the respondent PGIMER is appended as ANNEXURE C-6.

 

14.       That it is most humbly submitted that the complainant brought his wife Smt. Rekha Devi for her second pregnancy in a hail and hearty condition with normal running pregnancy and with no prior history of any abdominal surgery or TB etc. except Lower Segment Caesarean Section (LSCS) and the diagnose of Pyoperitonium is in no manner a complication/implication or after effect of caesarean section as performed by respondent No.2 to 4 on the wife of the complainant. It is further most humbly submitted that the presence of 500-600 ml of puss as well as vegetable material in the Peritonium/abdomen (not uterus) of Smt. Rekha Devi clearly shows that the doctors respondent No.2 to 4 while performing the C-Section surgery on 01.09.2015 had in a careless and negligent manner teared/ripped the intestines of the patient Smt. Rekha Devi on account of which there developed infection in the Peritonium/ abdomen (not uterus) resulting in huge quantity of puss as well as presence of vegetable matter in the abdomen……”

 

2.           Thus, according to the complainants, there was a sheer negligence and carelessness on the part of the opposite parties due to which Smt.Rekha Devi lost her life on 06.09.2015 at 3.15 pm., on account of septic shock/acute renal failure with antecedent cause of puerperal sepsis.
3.              The averments made in the consumer complaint were controverted by the opposite parties, as under:-

“8.       That the contents of this para are vehemently denied. It is preposterous to read the ultra sound report of the patient in the manner it is attempted to be done. This only shows little or no medical knowledge of the complainant. On 4.9.15 morning, her pulse rate was 98- 108/mt; BP was 96/60 – 100/70 mmHg, respiratory rate was 26/mt, temperature (99F- 98F). There was mild abdominal distension and bowel sounds were present. Inj. Ranitidine was given and Ryle’s tube was inserted. Serum electrolytes were checked that were in normal range: sodium: 138 and potassium 4.6. X-Ray abdomen was done that showed minimal air-fluid levels. Ultrasound of abdomen showed mild ascitis (mis free fluid in the abdomen). This is not synonymous with perforation or tearing of intestines. Intravenous fluids were continued. Intravenous broad spectrum antibiotics were started (cefotaxime and metrogyl). Her TLC was 13,300. Patient was shifted from the private ward to High Dependency unit (HDU) in the gynae-emergency area.

In HDU, patient was having dyspnea. Respiratory rate was 28-30/mt, pulse 112- 146/mt, BP was 98/77- 110/70mmHg, Temperature 98F. Oxygen was given by ventimask. She was conscious, well oriented to time, place and person. Ultrasound was preated and it showed mild amount of free fluid. Ultrasound guided paracentesis was performed. Minimal amount (<1.0 ml) of purulent fluid was aspirated from the peritoneal cavity and was sent for culture. Antibiotics were further increased to higher generation (piperacillin-tazobactum, clindamycin and Amikacin). Compression Ultrasound was done and there was no evidence of deep vain thrombosis. Blood sugar was low (48mg/dl) for which IV dextrose was given. ABG showed pH of 7.37, oxygen saturation of 97.3%. Patient’s condition was assessed by anaesthesiologist on call who advised to continue same treatment and supplement oxygen by ventimask. Hb was 11.6gm%, TLC was 7300. Electrolytes were 135/3.83 in ABG sample.

 

9       That the contents of this para are not correct as stated. On 5/9/16 morning, her general condition did not improve. Her BP 90/60, Pulse 128- 146/mt, respiratory rate 28/mt, temperature 37C. Her urine output decreased (650ml over 9pm till 7am). Patient was examined by general surgeon. General surgeon’ opinion was free fluid pockets are very small and there is increased risk of bowel injury with drainage. X ray chest on 5.9.15 did not reveal any gas under the diaphragm that rules out gut injury. 2D echocardiography was done that was normal. Hb was 11.6; TLC was 6400. As there was no improvement despite intravenous broad antibiotics, and intravenous fluids, a decision for laparotomy was taken.

 

10     That the contents of this para are vehemently denied with all vigor at the command of the Opposite Parties. The whole case of the complainant is based upon this misreading of the CR record of the patient. Patient was shifted to emergency OT. Laparotomy was done by a team of obstetricians and general surgeon. As per notes, Intra-operatively pus was present (500-600 ML) that was drained and the peritoneal cavity was lavaged was saline. Intestines were thoroughly examined by the general surgeon and there was no evidence of gut injury. (Pg. 61 of the complaint) The pus that was drained was sent for culture- sensitivity and vegetable matter. (Pg. 63 of the complaint) Operative notes clearly mention that pus was sent to look for vegetable matter. Nowhere in the notes, it is mentioned that vegetable material was present. Reports of pathology are appended as Annexure R/1 (collectively).

During surgery, she was started on noradrenaline to maintain BP. She received 5 fresh frozen plasma and 1 unit blood transfusion. Duration of surgery was 1.5hrs during which urine output was 100 ml. At the end of surgery, her pulse was 136/mt, BP was 101/67. She was not extubated. Second ionotrope (dopamine) was added.

 

11     From Emergency OT, she was shifted to the ICU at 4pm. Pulse rate was 145/mt, oxygen saturation was 94%. Urine output between 2 to 4 pm was 200 ml. Hb was 11.5gm% and TLC was 6700.

 

12     That the contents of this para are not correct as stated. In the ICU, her urine output decreased. Urea was 92, creatinine was 2.. She was started on peritoneal dialysis immediately. She had fever on the night of 5.9.15. Antibiotics were changed to meropenem and vancomycin. Intotropic support was gradually increased to maintain BP (dopamine, adrenaline, nor-adrenaline and vasopressine). Patient died on 6.9.16 at 3:13 pm due to septic shock with acute renal failure.

 

13     That the contents of this para are a matter of record, hence require no reply.

 

14     That the contents of this para are vehemently denied with all vigor at the command of the opposite parties. As already elaborated in the preceding paragraphs, the whole case of the complainant is based upon this misreading of the CR record of the patient. Patient was admitted due to high blood pressure and labour was induced. Emergency caesarean section was done with consent due to non reassuring fetal heart rate. In post operative period, patient’s condition was monitored by on-duty doctors. Her condition was fair till second post-operative day. As she started manifesting problems as detailed above, requisite remedial measures were taken without delay. She had infection for which treatment was instituted as per standard guidelines. Without any delay, she was shifted to HDU. As she did not improve, repeat surgery (laparotomy) was done as early as the 4^th post-operative day. During laparotomy pus was thoroughly drained and peritoneal cavity washed. There was no evidence of gut injury on pre-operative investigations and during surgery. In post operative period, she received ICU care. Infections are known complications of any surgery. Sepsis in this patient was aggressively managed.

The complaint deserves outright dismissal with imposition of heavy costs for pursuing vexatious litigation, leading to mental agony and harassment for extremely dedicated and highly qualified professionals of a premier research institute. The opposite parties reserve their right to prosecute the complainant for the same, under appropriate provisions of law…..”

           

4.              Sh. Rajesh Garg, Senior Advocate, Counsel for the Opposite Parties assisted by Ms. Nimrata Shergill, Advocate had also placed on record original medical record alongwith its two xerox copies.
5.              During pendency of the earlier consumer complaint (461 of 2016), the complainant himself moved application for constitution of a medical board, to give its report in the matter, to which, no objection was given by counsel for the opposite parties. Accordingly, this Commission requested the Director, All India Institute of Medical Sciences (AIIMS) at Delhi to constitute a Board of two Doctors, in the rank of Professor and Additional Professor, to submit a report, after looking into the averments made by both the parties and on perusal of the entire medical record, which was sent to them.
6.               It is coming out from the record that thereafter, medical board was constituted and a report was received by this Commission from AIIMS, New Delhi, vide letter dated 21.03.2017, the contents whereof are reproduced hereunder:-

 “…….Subject: Report of the Medical Board constituted at AIIMS for expert opinion in compliance of orders dated 22.02.2017 vide MA/110/2017 titled Rajeev  Singh Meena Versus PGI,  of Hon’ble State Consumer Disputes Redressal Commission, Union Territory, Chandigarh.

****************

A medical board was constituted by the Medical Superintendent, AIIMS on subject  noted above. The Board consists of the following faculty members:

 

1.	Dr. V. Seenu Professor, Deptt.  of Surgery	-	Chairperson
2.	Dr. Neena Malhotra Professor, Deptt. of Obs. & Gynae	-	Member
3.	Dr. Vimi Rewari Professor, Deptt. of Anaesthesiology	-	Member
4.	Dr. Vijaydeep Sidharth Department of Hospital Administration	-	Member Secy.

               

The medical board has carefully perused the medical case records of Late Smt. Rekha Devi W/o Sh.  Rajveer Singh, provided by the Hon’ble State Consumer Disputes Redressal Commission, Union Territory, Chandigarh.

The medical board met on 21.03.2017 at 02:00 P.M in Room No.13, M.S. Office Wing, ground floor, AIIMS, New Delhi, and after examining the medical records, is of the opinion that medical care rendered in this instance is in sync with the standard medical practices in vogue. Hence , it is opined that on the basis of medical records review, there is no element of medical negligence.

 

Sd/-	Sd/-	Sd/-	Sd/-
(Dr. V. Seenu)	(Dr. Neena Malhotra)	(Dr. Vimi Rewari)	(Dr. Vijaydeep Sidharth)
Chairperson	Member	Member	Member Secy.”

 

 

7.              However, against the above-said report, the complainant filed objections by moving an application on 12.10.2017 stating that the medical board has failed to look into the averments made and then form an opinion. It was stated that heavy amount of puss was found in the peritoneal cavity, which may have resulted into death of the patient. An objection was raised by the complainant that the medical board constituted by AIIMS, New Delhi has failed to give any opinion, as to whether such a heavy amount of puss can be found in natural course in such a short spell of time or it was a result of pouring in some vegetable material on account of rupture of some organ. Request was made by the complainant to again refer the matter to the Medical Board constituted by AIIMS, New Delhi to give opinion on the following points, to which no objection was raised by the opposite parties:-

 

1. Whether in routine, in such like surgical operation(s), huge puss formation is possible?

 

2. Whether formation of puss in this case in peritoneal cavity was the result of pouring in some foreign material on account of rupture of any organ may be the intestines during surgery?

 

8.           Again, the matter was referred to the Director, AIIMS, New Delhi, to give opinion qua the points stated as above. Resultantly, Board of Doctors of AIIMS, New Delhi, submitted their fresh report dated 19.05.2018, relevant part of which is reproduced hereunder:-

 

“…………….Subject: Report of the Medical Board constituted at AIIMS for expert opinion in compliance of orders dated 16.04.2018 vide CC/461/2016 titled Rajeev  Singh Meena Versus PGI,  of Hon’ble State Consumer Disputes Redressal Commission, Union Territory, Chandigarh.

 

****************

 

A medical board was constituted by the Medical Superintendent, AIIMS on subject  noted above. The Board consists of the following faculty members:-

 

 

1.	Dr. V. Seenu Professor, Deptt.  of Surgery	-	Chairperson
2.	Dr. Neena Malhotra Professor, Deptt. of Obs. & Gynae	-	Member
3.	Dr. Vimi Rewari Professor, Deptt. of Anaesthesiology	-	Member
4.	Dr. Vijaydeep Sidharth Department of Hospital Administration	-	Member Secy.

               

The medical board has carefully perused the medical case records of Late Smt. Rekha Devi W/o Sh. Rajveer Singh, provided by the Hon'ble State Consumer Disputes Commission, Union Territory, Chandigarh Redressal

 

The medical board met on 19.05.2018 at 12:00 Noon in Room No. 13, M.S. Office Wing, ground floor, AIIMS, New Delhi. In view of the opinion sought by the Hon'ble State Consumer Disputes Redressal Commission, Chandigarh, it is submitted that huge pus formation generally does not happen in surgeries like LSCS except in certain situations which include but not limited to breach of sepsis during surgery, bleeding resulting in hematoma which can get infected, gut injury or forgotten foreign body.

 

As per the operative notes dated 05.09.2015, there is no mention of any foreign body or any ruptured gut.

 

Sd/-	Sd/-	Sd/-	Sd/-
(Dr. V. Seenu)	(Dr. Neena Malhotra)	(Dr. Vimi Rewari)	(Dr. Vijaydeep Sidharth)
Chairperson	Member	Member	Member Secy.”

 

9.           However, it is coming out from the record of earlier complaint that after receipt of second report, referred to above, instead of arguing the case, the complainant made a request to withdraw the case with liberty to file it again with better particulars. Accordingly, vide order dated 06.09.2018, the earlier complaint was  ordered to be dismissed as withdrawn.
10.              Now this complaint (476 of 2018) has been filed by Sh.Rajveer Singh Meena, himself and his two minor daughters namely baby Nishika and baby Charul, on almost similar grounds, yet, fresh allegations have been leveled by him, to the effect that the since the entire treatment and surgery was carried out under extreme unhygienic conditions in the hospital, as such, infection of the patient deteriorated which resulted into her death. Following additional allegations have now been made by the complainants in this complaint:-

 

“…..13.       That it is also most significant to mention the OPs not only failed to take precautions, stay prepared before LSCS and conduct it diligently but their extremely casual approach is apparent from even the "Consent Form". The possible risks, including "Risks associated with anesthesia, bladder, bowel injury, blood loss and need for transfusion of blood" have been added very carefully. However, there is no reference to any sort of infection, post-operative peritonitis, sepsis, multi-organ failure anywhere.

 

14.              That in the light of above facts and circumstances OPs are jointly and severally liable to compensate the Complainants on following counts:

 

(i)   OPS No. 2 to 4 failed to meet the accepted standards of medical practice and were negligent in the medical care they provided to deceased Smt. Rekha Devi. These departures and negligence, by way of examples and not limited to, include (in chorological order):

 

1. Failed to opt for Sterilization/Aseptic technic before conducting PV examinations, IOLS and ARM on deceased Rekha Devi.

 

2. Negligent examination. in conducting multiple PV on the patient & IOL (mechanically and pharmaceutically) without adopting proper aseptic precautions and hand hygiene protocols and then causing delay between ARM and the delivery.

 

3. Negligent in conducting the above procedures and that too in the most unhygienic manner and letting Smt. Rekha Devi's body be infected and hence failed to prevent the introduction of deadly Hospital Acquired Infection in the patient.

 

4. Failed to take precautionary steps as also failed to adopt prudent vigilance and monitoring of the patient for timely detection. & management of infection.

 

5. Negligent in shifting the patient from Labour Room to Private Room without caring for the signs & symptoms enough for diagnosing infection.

 

6. Failed to take proper post-operative care of the patient, causing inordinate & inexcusable delay in detecting post-operative peritonitis.

 

7. Failed to recognize the signs and symptoms of puerperal sepsis, including fever, pain in the lower abdomen, feelings of discomfort, headache, loss of appetite, increased heart rate, between 2.9.2015 and 4.9.2015, leading to septic shock and ultimate death of the patient.

 

8. Failed to take urine or blood samples to test for bacteria or use cotton swab to take culture of uterus of Smt. Rekha Devi earlier than 5.9.2015.

 

1. Failed to attend the patient timely and act immediately once the X-Ray, Ultrasound, Paracentesis were conducted on 4.9.2015.

 

10. Failed taking history of drug allergies.

 

11. Negligent in administering antibiotic therapy without any information on type of bacteria which caused infection.\

 

• For conducting delay as even after confirming pus in the peritoneal cavity, surgery was delayed for more than one day for no valid reason.

 

13. Having decided for surgery, the surgery of post-operative peritonitis was performed surprisingly by the Gynecologist. Even if it was to be performed by the Gynecologist, a surgical consultant should have been engaged from the very beginning in the conduct of the surgery, in the best interests of the patient.

 

• Failure of surgical resident to scrub to assist the Gynecologist as he only looked into the abdomen from a distance and only 'inspected' the small bowel & caecum from outside and certified their integrity & left. Proper assessment of bowel integrity involves loop by loop inspection and palpation and need to check not only small bowel & ceacum but also ascending colon, transverse colon, descending colon, sigmoid colon & rectum to certify bowel integrity. This was not done in this case for reasons best known to the OPs.

 

• Failure of examining thoroughly which was the whole bowel not done by a 'consultant surgeon' and it was left to a resident to just do a casual inspection, defies a serious professional approach.

 

16. Causing and unavoidable & wrongful death of and otherwise healthy patient.

 

17. Negligent in recording dates and times in the medical records and thereby preparing poor medical records, and also for entering casual noting.

 

18. Negligent in not mentioning issues of concern and the plan of care.

 

 

 

Insofar OP No. 1 hospital is concerned, it is directly liable on the following counts:-

 

1. Failure to maintain the minimum standards of asepsis and hand hygiene in the hospital. There is no check on what the doctors & staff do & how they do it.

 

2. Failure to assign the experienced and competent doctors for handling the deceased Rekha Devi's case.

 

3. Failure to adopt a mechanism for monitoring patient care and the conduct of the doctors' & staff. When the LSCS was done by OP 2 to 4 resulted in post-operative peritonitis due to hospital acquired infection, the doctors & staff were still complacent & indifferent in their approach.

 

4. Failure to immediately transfer the case to the surgical consultant or to assign surgical consultant to operate alongwith the Gynecologist when the complication of post operative peritonitis had become clear and re operation was decided.

 

5. Failure to quickly assign a surgical consultant when Gynecologist was suspicious and called a resident instead of consultant.

 

6. Failure in administering the hospital without SOPs and care protocol, rendering its working more like a small nursing home with autonomous & arbitrary working of the doctors & staff, playing with the lives of their patients.

 

 

7. Failed to timely provide the culture reports to the doctors, so that antibiotics therapy could be tailored according to the type bacteria.

 

8. Manipulation and fabrication of medical

 

1. Not providing the medical records to the complainant for several days.

 

11.              The opposite parties denied all the allegations leveled by the complainants and maintained their stand by way of filing reply, wherein, almost similar to what was stated by them in the earlier complaint, which has been extracted above. However, it has been vehemently denied that there was unhygienic condition in the hospital.
12.              We have heard the contesting parties and have gone through the entire record of the case, very carefully, including the written arguments.
13.              Bare perusal of the record and also from the arguments of the parties, it could be collected that on examination of the patient  in OPD on 31.08.2015 (at 38 weeks and 2 days of pregnancy), her blood pressure was found high i.e. 140/100 and urine albumin was 1+ as a result whereof, she was admitted in the hospital and was diagnosed to have pre-clampsia and needed delivery. The patient opted for vaginal delivery and, as such, labour was induced. PV and ARM examinations were conducted. It is also coming out that during labour, the fetal heart rate (CTG tracing) was noted to be non-reassuring and therefore,  decision for emergency caesarean section was taken. The patient was receiving intravenous ampicillin six hourly and after consent, she was shifted to Emergency OT. LSCS was performed and girl was born at 6:12pm on 01/09/2015. When after post-operative period, she was shifted back to labour room, tntravenous ampicillin was changed to oral amoxicillin 500mg 8 hourly. Her pulse (76- 84/mt) and BP (140/80- 130/70) were normal and abdomen was soft. Urine output was adequate (820ml over 12 hrs). Her catheter was removed on 02.09.2015, following which she was voiding urine normally and also there was no vomiting by the patient. Her respiratory rate was normal (20/mt). On 03.09.2015- morning, she was examined by doctor-on-duty. Her pulse rate was 86/mt and blood pressure was 130/90mmHg and also did not show any fever. Respiratory rate was 20/mt. On 03.09.15-evening her BP was 100/70 and pulse was 84/min and again did not show any fever. Her abdomen had mild distension and was examined. There was mild gaseous distension and bowel sounds were sluggishly present. On 04.09.2015 morning, her pulse rate was found to be 98- 108/mt; BP was 96/60- 100/70 mmHg, respiratory rate was 26/mt, temperature (99F- 98F). There was mild abdominal distension and bowel sounds were present. Inj. Ranitidine was given and Ryle's tube was inserted. Serum electrolytes were checked that were in normal range: sodium: 138 and potassium 4.6. X-ray abdomen was done that showed minimal air-fluid levels. Ultrasound of abdomen showed mild ascitis (mild free fluid in the abdomen. She was shifted from the private ward to High dependency unit (HDU) in the gynae-emergency area. On ultrasound, guided paracentesis very minimal amount of fluid was aspirated, for which some medicines were given. Hb was 11.6gm%, TLC was 7300. Electrolytes were 135/3.8. On 05/09/2015, there was no improvement despite intravenous broad spectrum antibiotics, and intravenous fluids, need of laparotomy arose. Patient was examined and it was felt that the free fluid was too less in amount and minimal invasive drainage would not be beneficial. Decision for laparotomy was taken, which was done by a team of obstetricians and general surgeon. Intra-operatively pus was drained. Left side of peritoneal cavity had dense adhesions and the left adnexa was obscured due to adhesions. On initial paracentesis, very minimal amount of fluid was retrieved, hence, sent for C/S only. The pus that was drained during laparotomy was sent for culture-sensitivity and look for vegetable matter.

                   It is pertinent to mention here that we did not find mention anywhere to the effect that vegetable material was found present at any stage in the case of the patient. Thus, the moment the patient showed the signs of infection, appropriate measures were taken by the opposite parties. She received ICU care from the opposite parties. It may be stated here that infections are known complications of cesarean section. Any surgical procedure carries the risk of immediate and late complication. In the present case, sepsis in the patient was handled by the opposite parties with due care but unfortunately she could not survive.

14.              In our considered opinion, to prove any medical negligence, there should be material available on record or else appropriate medical evidence should be tendered or any expert report consisting of specialist doctors in the field. In the instant case, apart from the allegations made by the complainant before this Commission, no medical evidence was tendered to indicate negligence on the part of the opposite parties, who have very well explained their position relating to medical process to assert that there was no medical negligence on their part.

                   Not only as above, on the request of the complainant himself, the case was referred to the Director, AIIMS, New Delhi, to give its report as to whether there was any medical negligence on the part of the opposite parties or not.  The expert panel gave a clear-cut report, extracted above, to the effect, that the medical care rendered in the instant case by the opposite parties to the patient is in sync with the standard medical practices in vogue and that after review of the medical record of this case, there is no element of medical negligence.

                However,  when the complainant was still not satisfied, on his request, the matter was again referred to the Director, AIIMS, New Delhi, to give opinion as to whether, in routine, in such like surgical operation(s), huge puss formation is possible; and that as to whether,  formation of puss in this case in peritoneal cavity was the result of pouring in some foreign material on account of rupture of any organ may be the intestines during surgery. It is significant to mention here that in response, the Board of Doctors of AIIMS, New Delhi submitted their fresh report dated 19.05.2018, wherein, it was clearly opined that  huge pus formation generally does not happen in surgeries like LSCS except in certain situations which include but not limited to breach of sepsis during surgery, bleeding resulting in hematoma which can get infected, gut injury or forgotten foreign body. Yet, at the same time, it was also made clear in the said report that as per the operative notes dated 05.09.2015, there is no mention of any foreign body or any ruptured gut. Thus, in both the reports, there was not an iota of evidence wherefrom it could be revealed that there was any medical negligence on the part of the opposite parties.

15.              However, it has been noticed by this Commission that when the complainant did not find anything favourable in the aforesaid two expert reports, he finally withdrew the earlier complaint and again filed this complaint with a fresh allegations out of which he dominated mainly on the ground that since the opposite parties failed to maintain proper hygiene in the hospital, it resulted into infection to the patient, as a result whereof, it deteriorated and she died. It is very important to mention here that in the earlier complaint, no such allegation of want of proper hygiene in the hospital, was taken by the complainant. It appears that when the complainant saw that he has lost his case on merits, in the face of the reports referred to above, he wants to defeat the opposite parties, by taking new objections and that too without any evidence, which are not sustainable in the eyes of law. Our this view is also supported by the action of the complainant only because had such a bad and unfortunate experience been faced by him in the said hospital, then he would not have again availed the services of the opposite parties again, for birth of a baby from her second wife, which fact has not been disputed by him.
16.              In  view of peculiar facts and circumstances of this case, it is held that mere failure of treatment cannot automatically make the medical professional liable for medical negligence and also every death of a patient cannot on the face of it be considered as death due to medical negligence unless there is material on record to suggest to that effect. A professional may be held liable for negligence on one of the two findings: either he is not possessed of the requisite skills, which he claims or he does not exercise, with reasonable competence in the given case, the skill which he possesses. The standard to be applied for judging, whether the person charged has been negligent or not, would be that of an ordinary competent person exercising ordinary skill in that profession. A highly skilled professional may be possessed of better qualities, but that cannot be made the basis or the yardstick for judging the performance of the professional proceeded against on indictment of negligence. In the present case, perusal of the aforesaid reports clearly goes to show that the expert panel clearly ruled out the element of medical negligence on the part of the opposite parties by holding that they have examined the medical records and of the opinion that medical care rendered in this instance is in sync with the standard medical practices in vogue and that there was no element of medical negligence on the part of the opposite parties.
17.              As stated above, the complainant has led no evidence of experts to prove the alleged medical negligence except his own affidavit. A perusal of the medical record produced does not show any omission in the manner of treatment. The experts of different specialties and super-specialties were available to treat the course of treatment of the patient. The doctors are expected to take reasonable care but none of the professionals can assure that the patient would overcome the surgical procedures. There was never a stage when the patient was left unattended. The patient whose condition became critical during treatment and if she could not survive even after surgery, the blame cannot be passed on to the Hospital and the Doctors who provided all possible treatment within their means and capacity. No doctor can assure life to his patient but can only attempt to treat his patient to the best of his ability, which was being done in the present case as well. Therefore, we do not find that the Hospital and the Doctors guilty of medical negligence. Our this view is supported by the ratio of law laid down by the Hon’ble Supreme Court of India in Dr. Harish Kumar  Khurana Vs. Joginder Singh  &  Ors., Civil   Appeal   No. 7380  of  2009  decided  on 07.09.2021. Relevant part of the said order is reproduced hereunder:-

 “…. it is clear that in every case where the treatment is not successful or the patient dies during surgery, it cannot be automatically assumed that the medical  professional was negligent. To indicate negligence there should be material available on record or else appropriate medical evidence should be tendered. The negligence alleged should be so glaring, in which event the principle of res ipsa loquitur could be made applicable and not based on perception. In the instant case, apart from the allegations made by the claimants before the NCDRC both in the complaint and in the affidavit filed in the proceedings, there is no other medical evidence tendered by the complainant to indicate negligence on the part of the doctors who, on their own behalf had explained their position relating to the medical process in their affidavit to explain there was no negligence ….”

 

18.           Consequently, the present complaint is dismissed with no order as to costs.
19.           Certified Copies of this order be sent to the parties, free of charge.
20.     The file be consigned to Record Room, after completion.

Pronounced.

28.01.2022

Sd/-

[JUSTICE RAJ SHEKHAR ATTRI]

PRESIDENT

 

 

Sd/-

(PADMA PANDEY)

        MEMBER

 

 

 

Sd/-

(RAJESH K. ARYA)

 MEMBER

 Rg.