By Smt. C. S. Sulekha Beevi, President,
This is a complaint alleging medical negligence against opposite parties.
2. First complainant is the mother of deceased Sabitha Ansari. Second complainant is the son born to Sabitha in her earlier marriage to Sri. Hifsurahiman. This marriage ended in divorce. Sabitha was then married to 5th opposite party herein. It is stated that 5th opposite party is not keeping in touch with the complainants and so he has been arrayed as opposite party in this case. Sabitha had graduated in Maths and also held a B. Ed. Degree. She was working on temporary basis as a teacher at Peevees Model School, Nilambur. The minor (second complainant) is represented by guardian who is the first complainant.
3. During her second pregnancy, Sabitha availed treatment under third opposite party doctor working at first opposite party hospital. Complainants approached first opposite party hospital on the belief that third opposite party is an Obstetrician. On 10-05-2007 Sabitha was seen by third opposite party and scanning was also done. No abnormalities were detected. Her expected date of confinement was 05-7-2007. She experienced labor pain on 29-6-2007 and was taken to opposite party hospital. She was admitted at 6pm. She was constantly attended by third opposite party and there was nothing abnormal. At 11pm the first complainant was allowed into the labor room and she gave some coffee to Sabitha. At that time first complainant found Sabitha in a semi conscious condition. She was told by the nursing assistant that it was due to effect of medicines given to Sabitha and that there was nothing to worry. First complainant was the only by-stander as male members had not accompanied to the hospital because third opposite party had assured a normal delivery. At 11.30pm Sabitha felt giddy and collapsed suddenly. Third opposite party was called in by the nursing assistant. Seeing the panic of the doctors and staff the first complainant asked the doctors what was wrong. They did not give any information but only said that Sabitha has to be taken to Medical College Hospital, Calicut. Sabitha was immediately brought out of the labor room and was boarded into an ambulance. The third opposite party doctor, another doctor named Dr. Udayashanker, two nurses and the first complainant accompanied Sabitha in the ambulance. The first complainant saw the ice cold motionless body of Sabitha in the ambulance. By this time the brothers and relatives of Sabitha reached the hospital. But they were not permitted in the ambulance. Sabitha was taken to MIMS(Malabar Institute of Medcal Sciences) Hospital, Calicut. The relatives who accompanied the ambulance went to Medical College Hospital and only later came to know that she is taken to MIMS Hospital. They then reached MIMS hospital. By this time first complainant was informed that Sabitha and her baby are dead. She was informed by the doctors at MIMS hospital that Sabitha and her child were brought dead. First complainant then recollected that in the ambulance Sabitha was not given any medications or oxygen. It is stated that third opposite party brain washed the first complainant that if she insists for autopsy of Sabitha the body of the baby will also be subjected to autopsy and nothing would be gained. As the first complainant was terribly upset and grief stricken she did not insist for autopsy of Sabitha's body. It is alleged that the death of Sabitha and her child has occurred due to negligence on the part of opposite parties. It is suspected that opposite party administered wrong medicines. A few days after the incident, Sri Kabeer, the brother of Sabitha, approached opposite party hospital and requested for the treatment records. But respondents did not give the records. Later he moved an application under Right of Information Act. He was then manhandled by the security staff. He was admitted in a hospital. Police charged a case against him alleging causing destruction of hospital equipments. Thereafter copies of treatment records were given. These were illegible. The hand writing of third opposite party seen in the treatment records are different from the earlier prescriptions issued to Sabitha. The treatment records are manipulated. From MIMS hospital Sri. Kabeer was told that Sabitha and baby were brought dead but it is unable to state who died first. That there were other incidents in opposite party hospital of negligence in treatment and that first opposite party hospital is appointing persons who are not qualified. That doctors with M.B.B.S. Degree are appointed in the hospital and it is advertised that these doctors have specialty qualifications. A complaint was filed before the District Medical Officer and an inquiry was conducted. In the report submitted after inquiry it was stated that there is no negligence on the part of opposite parties. That the report is not convincing and that it is only a reproduction of the opinion given by third opposite party that death occurred due to cardiac and myocardial infraction. That opposite parties are bound to compensate the complainant. Hence this complaint claiming Rs.10,00,000/- as compensation along with costs.
4. First opposite party is the hospital in which Sabitha undertook treatment and second opposite party is arrayed as proprietor of the hospital. A combined version was filed by first and second opposite parties. It is submitted that for want of information and proof, opposite parties do not admit the marriage of Sabitha to Hifsu-rahiman. It is admitted that second opposite party is the proprietor of the hospital and that third opposite party is a gynecologist and fourth opposite party was R.M.O. attached to the hospital. It is submitted that Dr. Kalpana, third opposite party had attended Sabitha and she was admitted for confinement at 6pm. She was carrying her second pregnancy, delivered once and child living. She was admitted with full term pregnancy with labor pain and no other complaints.
5. At 7pm labor pain was progressing. ARM (artificial rupture of membrane was done). Injections Ampilox, Drothin, and later Epidosin was given. The patient was sent back to the room and advised to come if pain increases or any other problem. Later pitocin drip was started at 8 drops per minute. The patient was monitored regarding pulse, blood pressure and fetal heart. At 10.30 pm the patient was progressing well and regular monitoring was done. At 11.20pm third opposite party received a call from the duty nurses Ms. Lathika and Ms. Sindhu that the patient complained of sudden giddiness and that she collapsed. Third opposite party hurried to the labor room and on examination of the patient her pulse could not be recorded. Immediately Dr. Krishnaveni, fourth respondent was called for and also the anesthetist. Other staff also attended. Further treatment was started including CPR(resuscitation). Continuous CPR was done and ECG was monitored. There was no convulsions or bleeding. Third opposite party attended the progress of the delivery and made attempts to save the baby and the child but the PV findings was not favorable. Intravenous fluid was started and oxygen was given. Injections Efcorlin, atropin and adrenalin were administered. Dopamin drip was also started. CPR was again done. ECG monitor showed fibrillations waves. Defibrillatory shock was given thrice by the anesthetist and fibrillations waves were again visible. Meanwhile the condition and the risk was intimated to the by-stander, mother of Sabitha. The mother was advised that the patient has to be shifted to higher centers for ventilatory support and expert management. While shifting, the patient's ECG was not showing flat lines. But continuous fibrillation waves could be seen. Third opposite party accompanied the patient along with anesthetist and two sisters, Babitha and Lathika. The patient 's mother also accompanied in the ambulance. Continuous ambu-bagging was done with oxygen supply through E-tube and injection Dopamine drip and IV Saline was on the flow. On reaching MIMS hospital the patient was handed over to the emergency department there. The hospital authorities connected the patient to the ECG monitor and the doctor informed that the patient is dead. That third opposite party and all doctors and staff at opposite party hospital have attended Sabitha with care and caution and that due diligence was exercised. The doctors have followed standard and medically accepted procedures as expected from a qualified obstetrician. Allegations in the complaint are denied specifically. There was no failure on the part of opposite parties to render treatment to Sabitha. The allegation that wrong medicine was administered is denied. The death of Sabitha or the baby was not due to any negligence on the part of opposite parties.
6. The allegations that brother of Sabitha requested for treatment records and that it was refused by opposite party is denied. No such request was made. All treatment records as requested were provided. The allegations that hand writing in the treatment record is different and that records are manipulated are denied. The allegations that MBBS doctors are appointed and advertised as specialist is denied. The further allegations that there were other such instances etc; are denied. It is admitted that the District Medical Officer had conducted inquiry based on the complaint filed by the complainants. Opposite parties were exonerated on the finding that there is no negligence. That therefore this complaint is not maintainable. Opposite parties have not committed any deficiency and are not liable to compensate the complainants.
7. Notice was issued to third opposite party by registered post. Notice was returned as 'addressee left, present address not known'. Complainant filed I.A.254/209 for substituted service against third opposite party. Notice was served by publication. Third opposite party was set exparte on 30-6-2009.
8. Fourth opposite party filed a separate version adopting almost all the contentions raised in the version of first and second opposite parties. The allegations of medical negligence are denied. It is submitted that at 11.25pm, fourth opposite party got a call from the receptionist followed by another call from the labor room. Opposite party immediately rushed to the labor room and when opposite party reached the labor room she saw Sabitha intubated and CPR was going on. Continuous CPR was done and monitor was connected. Intravenous fluid was started and oxygen was going on. Injections Efcorlin, Atropin, and Adrenalin were given. Dotamin defibrillatory shock was given thrice by the anesthetist and fibrillating waves were seen again. Meanwhile the condition and risk was intimated to the bystander. The patients mother was advised that the patient has to be immediately shifted to a higher center for ventilator support and expert management. While shifting the patient ECG was not showing flat lines but continuous fibrillating waves were seen. Dr. Kalpana accompanied the patient along with anesthetist and two sisters (labor room staff). The patient's mother also accompanied in the ambulance. Later opposite party got information that the patient died . The cause of death is not known to this opposite party. The patient was given all basic life supports and that death did not occur due to any negligence on the part of opposite parties. The hospital including fourth opposite party had exercised due diligence and care and has followed the standard and medically accepted procedure as is expected from a qualified doctor in an identical situation. Allegations and averments in the complaint are denied specifically as baseless, without substance and as ill motivated. That third opposite party is a well qualified obstetrician and has acted to the best of her abilities. The death of Sabitha and her baby is not due to any latches, negligence, lack of care or mismanagement. That there is no deficiency in service and that complainants are not entitled to any compensation.
9. Evidence consists of the oral evidence of first complainant who was examined as PW1 in the case. PW 2 is the witness examined on the side of complainant. Ext.A1 to A10 marked for complainants. Fourth opposite party was examined as DW1 and no documents marked for opposite parties.
10. Points for consideration:-
(i) Whether opposite parties are deficient in service?
(ii) If so, reliefs and costs.
11. Point (I):-
To avoid repetition the facts are not narrated again. Complainants allege that the death of Sabitha and her baby occurred due to the negligence in treatment on the part of opposite parties. At the outset it has to be stated that the body of Sabitha was not subject to postmortem and therefore there is no document showing the cause of death of Sabitha or her baby. Ext A10 is a certificate issued by MIMS hospital in which it is seen stated that 'Sabitha, a full term pregnant lady was brought 30-6-2007 from P.G. Hospital, Nilambur in an ambulance accompanied by doctor and nurses with ET tube in situ and ambu bag ventilation. On examination pulse and BP were not record able and pupils were dailated and fixed. The patient was declared dead on arrival. 'Though the complainants allege that Sabitha died from opposite party hospital, there is no evidence to hold any probability in this regard. Ext A4 is a complaint preferred by the first complainant to the District Collector alleging the very same grievance. An enquiry was conducted under the direction of the District Medical Officer. Ext.A5 is the enquiry report submitted by the team of experts in the case on 21.12.2007. The team consisted of Dr.N.M. Sebastian - Deputy DMO, DrJose Pomson -Distridt RCH officer, Dr.Narayanan, Senior Gynecologist from Distict Hospital Manjeri. It is seen from Ext A5 that third opposite party was also present before the team of experts in the course of enquiry. It is also stated that death must have occurred during the travelling from Nilambur to MIMS hospital i.e, between 12.30am -1.20am on 30-6-2007. Regarding the death of child, Dr. Kalpana opined that the child must have died earlier than the mother due to decreased oxygen during collapse and BP fall. Regarding the cause of death Dr. Kalpana could not find a reason, but she thinks the probable cause of death could be cardiac -myocardial infraction, cardiomyopathy or aortic aneurysm rupture. Since autopsy was not done final diagnosis could not be reached. After enquiry the finding stated by the experts in Ext. A5 is reproduced as under:
“As per the hospital records produced by the hospital the team cannot find any fault as far as the management of the case is concerned.”
It is for the complainant to adduce expert evidence to establish the negligence of opposite parties. No such evidence either as medical literature or oral evidence has been placed before us on the side of the complainant. In the box PW1 has renegated from her contentions raised in the affidavit. She has deposed as under:
“ഞാന് ബോധിപ്പിച്ച affidavit-ല് പറഞ്ഞ കാര്യങ്ങള് വായിച്ചുകേട്ട് മനസ്സിലാക്കിയിട്ടുണ്ട്. എന്റെ അന്യായത്തിലെ ആരോപണങ്ങള് തെളിയിക്കുവാനാണ്1 മുതല് 10 വരെ രേഖകള് ഞാന് ഹാജരാക്കിയിട്ടുളളത് എന്നു പറഞ്ഞാല് ശരിയാണ്. ഈ രേഖകളെക്കുറിച്ച് എനിക്ക് നേരിട്ട് അറിയാവുന്നതാണ്. ഈ രേഖകള് കൊണ്ട് (Ext.A1 to A10) ഒന്നും രണ്ടും നാലും എതൃകക്ഷികളുടെ ഭാഗത്തു നിന്നും എന്തെങ്കിലും കൃത്യവിലോപമോ, അശ്രദ്ധയോ, കാണില്ല എന്നു പറഞ്ഞാല് എനിക്ക് അറിയില്ല. A1 to A10 രേഖകള് കൊണ്ട് കൃത്യവിലോപവും സേവനത്തില് അപര്യാപ്തതയും കാണില്ല എന്നു പറഞ്ഞാല് ശരിയാണ്.” അശ്രദ്ധയും
“Ext A5 enquiry report-ല് 3- opposite party doctor-റുടെ ഭാഗത്ത് സേവനത്തില് വീഴ്ചയോ, അശ്രദ്ധയോ കാണുന്നില്ല എന്നു പറഞ്ഞാല് ശരിയാണ്. 1- opposite party ആശുപത്രിയില് വളരെ വിദഗ്ദരായിട്ടുളള doctor-മാരാണ് ഉളളത് എന്നു പറഞ്ഞാല് നല്ല doctor-മാരാണ് എന്ന നിലക്കാണ് ആ ആശുപത്രിയില് പോയത്. എന്റെ മകള്ക്ക് തെറ്റായ മരുന്നുകളാണ് കൊടുത്തത് എന്ന് affidavit-ല് പറഞ്ഞത് കേട്ടുകേള്വിയുടെ അടിസ്ഥാനത്തിലാണ്.“
"എനിക്ക് ആശുപത്രിയിലെ doctor-മാരുടെയോ nurse-മാരുടെയോ കൈയക്ഷരം കൃത്യമായിട്ടറിയില്ല. ഞാന് Collector-ക്കും മറ്റും കൊടുത്ത പരാതികളില് അന്വേഷിച്ച് report എനിക്ക് ലഭിച്ചിട്ടുണ്ട്. ആ report-ന്മേല് തുടര്നടപടികള് ഞാന് സ്വീകരിച്ചിട്ടില്ല. ഇതിനു മുമ്പും ആശുപത്രിയില് ഇതുപോലുളള സംഭവങ്ങള് ഉണ്ടായിട്ടുണ്ട് എന്നു കാണിക്കാന് യാതൊരു രേഖകളും ഞാന് ഹാജരാക്കിയിട്ടില്ല. അങ്ങനെ യാതൊരു സംഭവങ്ങളും ഉണ്ടായിട്ടില്ല എന്നും കേസിന്റെ ബലത്തിനുവേണ്ടി പറയുകയാണ് എന്നും പറഞ്ഞാല് ശരിയല്ല . അപ്രതീക്ഷിതമായും സ്വയംഭൂവായും ഒരു വ്യക്തിക്ക് complication വന്നേക്കാം എന്നു പറഞ്ഞാല് ശരിയാണ്. Opposite partyആശുപത്രിയിലെ doctors-ഉം staff-ഉം highly qualified ആണ്എന്നു പറഞ്ഞാല് ശരിയാണ്. വൈദ്യശാസ്ത്രത്തിലുളള അജ്ഞതകൊണ്ടും തെറ്റിദ്ധാരണകൊണ്ടും ആണ് പരാതി കൊടുത്തത്എന്നു പറഞ്ഞാല് ശരിയാണ്.”
PW2 is the brother of PW1. He deposed that he received treatment records from opposite party hospital after giving a written request. But no such records are seen produced on the side of the complainant. Ext.A1 series are only medical bills. There is nothing brought out by the oral evidence of PW2 supporting the allegations in the complaint. He has stated that he was not at the hospital at the relevant time and has given complaint to the District Collector alleging that wrong medicine was administered to Sabitha only on the basis of hearsay. On behalf of opposite parties the fourth opposite party has graced the box and was examined as DW1. She has deposed in consonance with the contentions in the version. It is stated by DW1 that during active labor the cardiac went into failure. It is also stated that opposite parties insisted for autopsy but the relatives of the deceased were not willing. There is no challenge made in the method of treatment adopted by opposite parties. There is nothing brought out in evidence or materials placed before us to lead us to the conclusion of negligence on the part of opposite parties. Over and above there is no expert evidence adduced to countermand Ext.A5 expert inquiry report submitted by a team of experts.
12. A young lady along with the child in her womb have lost their lives. The question is whether the fatality is attributable to the service availed. We have to answer this in the negative. So long as a doctor follows a practice acceptable to medical profession of that day, he cannot be held liable only because things did not go in a way as expected. The liability in tort is restricted to those cases where there is real failure to behave as a reasonably competent practitioner would have behaved. On the above discussions we hold opposite parties not deficient.
13. In the result the complaint is dismissed. Parties shall bear their respective costs.
Dated this 7th day of April, 2011.
Sd/-
C.S. SULEKHA BEEVI, PRESIDENT
Sd/-
MOHAMMED MUSTAFA KOOTHRADAN, Sd/-
MEMBER E. AYISHAKUTTY, MEMBER
APPENDIX
Witness examined on the side of the complainant : PW1 and PW2
PW1 : Ayisha, W/o Aboobacker, first complainant.
PW2 : Abdul Kareem.M. Brother of PW1.
Documents marked on the side of the complainant : Ext.A1 to A10
Ext.A1(series): Cash bills (3 Nos.) and prescriptions (3 Nos.) from opposite party to complainant.
Ext.A2 : Letter No.M6-21901/07 dated, 31-01-2008 from Public Information
Officer/District Medical Officer, Manjeri to PW2
Ext.A3 : Letter dated, 31-8-2007 by PW2 to Medical Officer, MIMS Hospital, Kozhikkode.
Ext.A4 : Complaint dfated, 26-8-2007 by the first complainant to the District Collector.
Ext.A5 : Enquiry report submitted by the team of experts.
Ext.A6 : Photo copy of the certificate dated, 21-3-2001 given by University of Calicut to deceased Sabitha.
Ext.A7 : Photo copy of the certificate dated, 11-6-2004 given by University of Calicut to deceased Sabitha.
Ext.A8 : Certificate dated, 20-5-2008 given by Principal, Peevees Model School, Nilambur
to deceased Sabitha.
Ext.A9 : Photo copy of the request dated, 02-7-2007 by PW2 to first opposite party.
Ext.A10 : Certificate issued by Dr. Shyam Sarat, Medical Registrar, MIMS hospital.
Witness examined on the side of the opposite parties : DW1
DW1 : Dr. Krishnaveni, P.G. Medical Trust Hospital, Nilambur.
Documents marked on the side of the opposite parties : Nil
Sd/-
C.S. SULEKHA BEEVI, PRESIDENT
Sd/-
MOHAMMED MUSTAFA KOOTHRADAN, Sd/-
MEMBER E. AYISHAKUTTY, MEMBER
