Tamil Nadu

StateCommission

CC/6/2013

P. SHANMUGAM - Complainant(s)

Versus

SEI SAI SPECIALITY HOSPITAL, DIRECTOR - Opp.Party(s)

V. BALU

14 Jul 2023

ORDER

 IN THE TAMIL NADU STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI.

 

Present:Hon’ble Thiru. Justice R.SUBBIAH       ... PRESIDENT

             Thiru.R VENKATESAPERUMAL     … MEMBER

 

C.C. No.6 of 2013

                                                    

                               Orders pronounced on: 14.07.2023

P.Shanmugam,

S/o.G.Poongavanam,

Plot No.238,

Janakiram Nagar,

Shevvapet Road,

Thiruvallur District 602 025.                                … Complainant

 

vs.

 

1.Srisai Speciality Hospital,

Rep. by its Director,

35, 36 Masilamaneeswar Nagar,

Behindsiva Temple,

Thirumullaivoyal,

Chennai 600 062.

 

2.Dr.R.Anuradha,

Srisai Speciality Hospital,

35, 36 Masilamaneeswar Nagar,

Behind Siva Temple,

Thirumullaivoyal,

Chennai 600 062.                                 … Opposite Parties

 

             For Complainant      : Mr.V.Balu

             For Opp. Parties       : M/s.AAV Partners

 

This Complaint came up for final hearing on 30.09.2022 and, after hearing the arguments of both sides and perusing the materials on record and having stood over for consideration till this day, this Commission passes the following:-

O R D E R

R.Subbiah, J. – President.

 

                      Alleging that the OPs have committed medical negligence by their failure to remove the placenta after the complainant’s wife had delivered baby through the LSCS Procedure performed by the 2nd OP at the 1st OP and that, as a result thereof, his wife had died of the fatal complications in the form of over-bleeding caused by the retained placenta, the complainant has filed the present case against the OPs, seeking to direct the latter to pay to him a total compensation of Rs.49.80 lakhs under the heads - loss of life; hospital charges incurred; loss of expected income of the deceased; loss of consortium; mental agony caused to the minor children due to deprivation of mother’s love, care and affection; and costs of the proceedings.  

 

             2. The crux of the averments in the Complaint is as follows:-

             The complainant was married to one Revathi and the couple had a female baby.  The said Revathi became pregnant again in 2011 and, from the beginning of the pregnancy, the couple had consulted the 2nd OP, who had advised to take the first scan on 18.08.2011 during the 10 – 11th week of pregnancy and the next scans for the 16th, 23rd and 34th week were taken on 18.09.2011, 25.10.2011 and 16.01.2012 respectively.  Thereafter, upon the advice of 2nd OP, the complainant’s wife was admitted for delivery in the 1st OP/Hospital on 23.02.2012. On the next date/24.02.2012, at around 6 AM., by stating that the patient is urgently required to undergo Caesarian, the 2nd OP obtained the signature of the complainant’s wife in his presence, without even informing or explaining the course & nature of the procedure, the possible risks & complications involved therein, additional facilities available in the 1st OP to meet any emergency, etc; as such, it was not an informed consent.  At 7 PM., it was intimated by a Nurse and the 2nd OP that the complainant’s wife had given birth to a female child.  While the mother of the complainant as well as his mother-in-law were eager to know the condition of the patient, at around 12 PM., the patient had the complaint of vomiting, yet, her condition was not informed either to the complainant or to the relatives present there.  The Duty Doctor / Nurse available at that time had administered an injection to her and they did not reveal her actual condition and also the reason for sudden vomiting.  Thereafter, at about 12.15 PM., to the utter shock of the complainant, he was informed by the 2nd OP that his wife had died. The grief-stricken complainant and his relatives present there made repeated enquires and only thereafter, the 2nd OP reluctantly told that she had died due to thrombo-embolism.  The complainant could not believe the reason given by the 2nd OP and hence, at 4 PM., he lodged a complaint with Thirumullaivoyal Police Station, resulting in registration of Cr. No.270/12 under Section 174 Cr.P.C.  After the post-mortem done on 25.02.2012, the report was referred to the Forensic Sciences Department from where, the Police Surgeon received a report on 19.03.2012 and the reason stated therein is “Retained Placenta”. Retained Placenta might occur because the placenta becomes trapped behind a partially closed cervix or because the placenta is still attached to the uterine wall, either loosely (adherent placenta) or deeply (placenta accreta).  If left un-cleared, a retained placenta can cause severe infection or life-threatening blood-loss in the mother. After delivery, the 2nd OP informed that all parameters of his wife were normal and the complainant believed the same, but, after seeing the post-mortem report, he came to know that the 2nd OP failed to remove the placenta after surgery and such lapse is totally against the medical ethics. It is the foremost and fundamental duty of the Doctor, who performs the Surgery, to clear the placenta present in the entire uterus before sutures are made.  The 2nd OP, who was duty-bound to examine the patient’s uterine cavity to make sure that it is empty and that the placenta is delivered, failed in exercising due care and caution in removing the pieces of membrane and clots and such gross negligence on the part of the OPs, in particular the callous and lethargic attitude of the 2nd OP in performing her duty to provide due post-operative care, had ultimately led to the death of the patient due to over-bleeding.  While the report given by the Police Surgeon is very clear to the effect that the cause of the death is the retained placenta, the reason given by the OPs for the death of the patient is totally misleading that amounts to clear suppression of facts. Now, the complainant is put to immense hardship as his other child and the new-born baby are both deprived of the mother’s affection and care. The complainant, who is thus subjected to severe mental agony & torture as well as monetary loss,  in August, 2012 had issued a legal notice, for which, the 2nd OP sent an evasive reply, suppressing the truth.  Hence, the present Complaint against the OPs, seeking the relief as aforementioned.

 

             3. In their written version, after giving specific details of the course of treatment provided to the patient, the OPs denied the allegation of medical negligence by inter alia stating thus:-

             Prior to the present Caesarean Operation performed to the patient, she had undergone a similar procedure about 1 year and 1 month ago in the Government Kasthurba Gandhi Hospital for twins and one of the twins, a male baby, had died 10 days after the delivery. While as per the medical literature, there should be at least a gap of 3 years for an operative delivery, the patient, who was an obese, had to undergo the 2nd Caesarean in a shorter interval as she conceived 4 months after the 1st delivery.  The patient gave birth to a live female baby weighting 3.5 Kegs on 24.02.2012 at 7.27 AM. and, after removal of the placenta in toto, the uterine wound was sutured with No.1 vicryl.   Post-operatively, her pulse, BP reading and urine output were all good and there was no excessive bleeding per vagina.  While so, at 12.15 PM., she complained of vomiting and inj.Vomikind was given as per the instructions of the 2nd OP.   Suddenly, at 12.30 PM., she screamed and got up from the bed and suffered generalized convulsions with frothing in mouth, whereupon, oral & nasal suction was done, nasal O2 kept and, despite the cardiopulmonary resuscitation, her pupils dilated and the heart rate could not pick up and, at 12.45 pm., she was declared dead and the cause of death was suspected to be thromboembolism or a rare side-effect of inj.Vomikind. While it is true that a retained placenta, if untreated, can cause severe infection or life-threatening blood loss in the mother, in the case of the complainant’s wife, the 2nd OP not only removed the placenta in toto but also wiped the uterus with a dry gauze, also covering the sutured site of the previous LSCS.  The aspect that there is a possibility of Placenta Cells available in the previous sutured area in every operative delivery would come out naturally is evidenced by the following text in the medical literature - D.C. Dutta Text Book of Obstetrics – including Perinatology and Contraception – 5th Edition Page 451 under the head ‘Placenta Accreta’:-

               “Placenta Accreta is an extremely rare form in which the placenta is directly anchored to the myometrium partially or completely without any intervening deciduas.  The probable cause is defective decidula formation.  The condition is usually associated when the Placenta happens to be implanted in lower (Placenta praevia) or over the previously injured sites as in Caesarean section, dilation and curettage operation, manual removal synaecolysis of myomectomy.  ”

Further, such placenta cells would not cause any haemorrhage to the patient or that it would cause death.  Even if the biopsy report shows that there were placenta cells available in the uterus, the same cannot be termed as retained placenta.  Here, the 2nd OP removed the placenta along with the cord and membrane; as such, any noting made in the histopathology about placental tissue is only a normal finding. Further, as per medical literature, retained placenta will not immediately embolize into blood to produce epilepsy.  As there was no excessive bleeding per vagina, the post-partum convulsion and collapse could have been due to a rare side-effect of inj.Vomikind or cerebral thrombo emboli.  By denying all other allegations and, by stating that the manner in which the final opinion was given bereft of details in the Post Mortem Certificate by the Police Surgeon stating that the cause of death is due to retained placenta reflects his scant regard to the autopsy guidelines and hence, the same cannot be acted upon, the OPs sought for dismissal of the complaint.

 

             4. In order to substantiate the case and counter-claim, both sides have filed their respective proof affidavits and, while on the side of the complainant, 21 documents have been marked as Exs.A1 to A21, the OPs have marked 3 documents as Exs.B1 to B3.

 

             5. Learned counsel for the complainant submits, at the first instance that, upon the medical advice of the 2nd OP, when the complainant’s wife was admitted for delivery in the 1st OP Hospital on 23.02.2012, the 2nd OP informed that the patient had to immediately undergo C-Section and, in that regard, she obtained the signature of the complainant and his wife on 24.02.2012 at 6 AM., without even informing them about the probable complications of the procedure and about the availability of additional facilities or expertise in the 1st OP to meet any emergency situation that may arise from the procedure; therefore, it cannot be said that the 2nd OP had performed the surgery based on a clear informed consent. 

             Secondly, after announcing the birth of a female child at about 7 AM. on 24.02.2012, the OPs did not allow the complainant’s mother and his mother-in-law to see the patient when they wanted to know her condition; while so, at about 12 PM. the patient suddenly vomited and still her condition was not disclosed to the complainant’s relatives by anyone in the 1st OP.   All of a sudden at 12.15 pm., the 2nd OP casually declared the death of the patient by stating that the death was due to thromboembolism.  While so, subsequent to the steps taken by the complainant, post-mortem was conducted and forensic report was obtained which confirmed that the death of the patient was due to the effects of the retained placenta.  Thus, the medical negligence on the part of the 2nd OP that she failed to remove the placental matter post-surgery is well substantiated.  Inasmuch as it is clearly made out that the 2nd OP failed to properly inform the complainant/patient about the nature of the procedure and the possible complications that may arise there-from, either before or after the surgery; that she performed the surgery without due care and caution; and that she lacked in providing due post-operative care by not properly cleaning the uterus completely free from the placental matter which resulted in over-bleeding and consequential death of the patient; this Commission, by ultimately holding that the 2nd OP has committed medical negligence and that the complaint deserves acceptance, may grant the relief sought for in its entirety having regard to the fact that, as a result of the negligent and inappropriate treatment given by the OPs, the complainant lost his beloved wife and the two female children are now brought up by him without the love and affection of the mother.

 

             6. Per contra, learned counsel appearing for the OPs, by primarily referring to the following entry in the Ex.A17/Post-mortem Certificate –

       “On dissection of uterus:- the interior surface of the uterus is ragged and filled with multiple blood clots of 120 gms. Placental attachment areas are irregular and nodular, with tiny bits of placental tissue found attached to the uterus. Uterine and ovarian vessels : intact”,

submits that the blood clots and tiny placental tissues that were found by the Police Surgeon/Post Mortem Doctor cannot be termed at all as ‘retained placenta’.  That is why, not able to say anything about the diameter and the weight of the alleged ‘retained placenta’, the uterus was sent for examination by the Forensic Lab.  While so, when the Forensic Report under Ex.A17 only states that poison was not detected in any of the visceral items, quite contrary to the autopsy guidelines, without mentioning any relevant/further details he derived from the Forensic Report about the placenta, the Police Surgeon proceeded to give an absurd final opinion in the hand-written form to the effect that the deceased would appear to have died due to the effects of retained placenta.  According to him, the said opinion of the Police Surgeon cannot be given any face value at all having regard to the fact that not only the entire placenta was removed by the 2nd OP after the child-birth but also the uterus was completely wiped by a dry gauze and more importantly, the tiny placental tissues still stuck at the previous LSCS site/sutured area were also removed. It follows, the extraneous opinion of the Police Surgeon being the genesis for the complainant’s claim, the case built upon such an untenable view has lost its edifice.  In his further endeavor to demonstrate that the opinion written by the Police Surgeon lacks credence, learned counsel proceeds to point out that the Police Surgeon, who initially found in Ex.A17/Post-mortem Certificate, dated 25.02.2012, that there were only tiny bits of placental tissues found attached to the uterus and thereafter reserved his final opinion awaiting the forensic report for further details regarding the weight and width of the uterus so as to reach a precise conclusion about the placental aspect, after the Forensic Report, dated 19.03.2012, which seemingly pertains to the only point of detection or otherwise of poison in the viscera and nowhere it has any recorded details about the uterus and placental matter, suddenly jumps into the exercise of recording a final opinion below the Forensic Report in his own handwriting to the effect that the deceased would appear to have died due to the effects of retained placenta and, for giving such final opinion by way of a written endorsement without date below the forensic report, obviously, he has not cited any reference from the forensic report or explained as to how he could opine so contrary to his initial noting that what was noted by him previously was  only ‘tiny bits of placental tissue’; as such, the established line of procedure scrupulously followed by autopsy surgeons is given a clear go-bye in this case and therefore, the final opinion given by him cannot be given any face value or credence while considering the actual issues involved.

             He further states that the most common cause of death in patients undergoing pelvic surgery like C-Section is due to thromoboembolism, as could be evident from the medical literature – ‘Robins PATHOLOGIC BASIS OF DISEASE”; therefore, when the clinical examination only suggests either embolism to be the cause of death or the rare side-effects of Inj.Vomikind administered to the patient for vomiting and when the allegation of the complainant that the death of the patient was due to the retained placenta is without any iota of proof, the 2nd OP cannot be held liable for the death of the patient that had happened more than 5 hours after the surgery, particularly when it is borne out by records that the complainant’s wife was well & fine throughout the moments after the surgery for more than 5 hours and thereafter, the only ordeal she had faced during a short time before her death was vomiting followed by seizures that gripped her after she was administered inj.Vomikind for vomiting.  Learned counsel further states that the Police Surgeon ought to have done CT brain prior to post mortem so as to ascertain whether the patient died due to thrombo embolism, however, for the reasons best known to him, he did not do so.   Moreover, the complainant has not let in the expert evidence to prove any negligence on the part of the OPs and failure to do so would adversely affect his case and claim and, in this regard, learned counsel has pressed into service the following two decisions, one rendered by the National Commission and the other one by the Apex Court, and quoted the relevant passages there-from:

              I. Kamla Bai Pandey vs. P.C.Dwivedi and Ors (Revision Petition No. 233 of 2004 in Appeal No. 1331 of 2001 -   Decided On, 03 December 2008):-

          “ 5. ….. It was for the petitioner/complainant to prove as to what the Doctor did which he should not have done, or what he should have done and he did not do so? There is no expert evidence in support of the contentions advanced by the petitioner.  In view of the judgment (supra), we find that the petitioner has completely failed to prove the case of medical negligence against the respondent Doctor, whereas the first respondent Doctor has not only relied upon his evidence as a professional, he has also backed it up by the medical literature, in support of the line of treatment adopted by him.”

             II. Harish Kumar Khurana vs. Joginder Singh & Ors. (AIR 2021 SC 4690):-

        “  14. ….. 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.

             23. In the above circumstance when there was no medical evidence available before the NCDRC on the crucial medical aspect which required such opinion, the mere reliance placed on the magisterial enquiry would not be sufficient. Though the opinion of the civil surgeon who was a member of the committee is contained in the report, the same cannot be taken as conclusive since such report does not have the statutory flavour nor was the civil surgeon who had tendered his opinion available for cross-examination or seeking answers by way of interrogatories on the medical aspects. Therefore, if all these aspects are kept in view, the correctness or otherwise of the line of treatment and the decision to conduct the operation and the method followed were all required to be considered in the background of the medical evidence in the particular facts of this case. As indicated, the mere legal principles and the general standard of assessment was not sufficient in a matter of the present nature when the very same patient in the same set up had undergone a successful operation conducted by the same team of doctors. Hence, the conclusion as reached by the NCDRC is not sustainable.”

In the present complaint, without any expert evidence and tangible materials even to suggest any medical negligence, the complainant has laid his claim on a pure guesswork based on the absurd and extraneous opinion given by the Police Surgeon and further, in the given factual circumstances, the 2nd OP has acted at every stage with due clinical care and caution as per the required medical standards, however, unfortunately, the patient died most probably due to embolism or rare side-effects of inj.Vomikind, which mis-happening can only be said to be a medical accident, for which, none of the OPs can be sued for consumer liability and, on that basis, the complaint is liable to be dismissed at the threshold, learned counsel urged ultimately.  

 

             7.  We have given our thoughtful consideration to the rival submissions advanced on either side and meticulously perused the materials available on record.

 

             8. In the light of the main set of allegations projected on the side of the complainant that –

           i) the consent obtained from the patient is not an informed consent at all, since the complications that may arise from the LSCS procedure were not properly explained by the OPs;

          ii) no one was allowed by the OPs to visit the patient after she delivered the child; and

          iii) the patient had suffered profuse post-partum bleeding as a result of the retained placenta which the 2nd OP failed to remove negligently, causing the death of the patient;

and from the counter-arguments made on behalf of the OPs to the effect that –

             i) less than 2 years ago, the patient had already undergone a LSCS Surgery at the Government Kasthurba Gandhi Hospital for delivery of twins and one of the twins died about a week or so thereafter and thus, despite the patient and her husband/complainant being aware of the procedure pertaining to LSCS, the 2nd OP once again explained her in detail about the procedure at the time of getting the consent, therefore, the contrary allegation about informed consent is highly ill-conceived;

             ii) right after child-birth, not only the complainant but also his mother as well as the mother of the patient/complainant’s mother-in-law were all in the company of the patient and there was no excessive bleeding per vagina ever noticed by anyone including the said relatives as sought to be projected now by the complainant and further, the sudden convulsions developed in the patient at about 12 pm. after the injection administered to her for vomiting was before the very eyes of her relatives as well as the complainant himself  and hence, the said allegation is a blatant falsehood; and

            iii) few placental tissues that got stuck during the previous LSCS were still noticeable at the old sutured site and the 2nd OP, while removing the placenta in toto from the uterus, had also cleared the placental-tissue residues left over at the previous sutured site with a dry gauze and therefore, the very edifice of the complainant’s case built by drawing a wrong inference from the shallow conclusion of the police/autopsy surgeon crumbles to ground,

it would suffice to answer the following single question for disposing of this Complaint –

   “as to whether the case of the complainant that his wife had died due to post-partum over-bleeding on account of the medical negligence committed by the 2nd OP for her alleged failure to remove the placenta immediately after the delivery of the child through LSCS, is satisfactorily established or not so as to either grant or decline the relief sought for by him? ”

 

             9.  First of all, let us deal with the allegation of the complainant regarding informed consent by stating that the procedure regarding LSCS was never explained to the patient or the complainant and that the 2nd OP formally obtained the signature in the consent form in a hurried manner.  But, we find, neither the patient nor her husband/the complainant is rustic, rather, they are educated people employed in the Police Department and the complainant is attached to the Intelligence Unit of a Police Station.  After carefully perusing the consent form under Ex.B1, we are not able to draw any adverse inference in the matter of getting the consent of the patient.  Further, a perusal of the other documents would go to show that the patient had already undergone the very same procedure/LSCS at the Government Kasturba Gandhi Hospital for delivery of twins and that one of the twins had died about 8 or 10 days after delivery and that she had conceived about 4 months after the previous/first delivery performed through LSCS, however, very conveniently, the complainant suppressed those details and now projects as if his wife had undergone C-Section for the first time at the hands of the 2nd OP and that they never had any idea or knowledge about the said procedure. We are given to understand that there must be a time-gap of about 3 years for an operative delivery and, in the given instance, it seems, the patient had conceived about 4 to 5 months after her previous delivery by LSCS and that is why, the 2nd OP had clinically advised the patient to undergo LSCS, for which, due consent was also given under Ex.B1.  Therefore, the allegation on the aspect of consent is contrary to facts and it is only malicious in nature.

 

             10. The averments in the complaint as well as the arguments advanced on the side of the complainant give a picture as if the patient had suffered profuse post-partum bleeding that turned fatal for her and the said complication arose due to placenta retention which was not clinically addressed owing to the medical negligence of the OPs.  Obviously, the anchor-sheet for the case of the complainant to put forth the allegation of medical negligence against the 2nd OP on the ground of placenta retention is the final opinion offered by the Police Surgeon.  Therefore, let us carefully examine as to whether the said opinion offered by the police surgeon can, in the given facts and circumstances, be taken to be a conclusive proof to sustain the allegation of medical negligence.

             But, before that, it would be quite useful to look at the meaning of retained placenta, its causes and risks from a clear medical perspective.  In this regard, although the complainant has not cited any medical literature, on the side of the OP, reference is made to “D.C.Dutta Text Book of Obstetrics  - Including Perinatology and Contraception – V Edition 2001 under the Subject - “Retained Placenta” at page No.450” and the relevant passages there-from are reproduced below:-

                “Definition: The placenta is said to be retained when it is not expelled out even 30 minutes after the birth of the baby.

                CAUSES: There are three phases involved in normal expulsion of placenta : (1) Separation through the spongy layer of the deciduas.  Descent into the lower segment and vagina.  (3) Finally its expulsion to outside. 

                Interference in any of these physiological processes, results in retention:-

  • Placenta completely separated but retained is due to poor voluntary expulsive offers specifically following exhaustive and prolonged labour.
  • Simple adherent placenta is due to uterine atonicity in cases of ground multipara, over distension of uterus, prolonged labour, uterine malformation or due to bigger placental surface area.  The commonest cause of retention of non-separated placenta is atonic uterus.
  • Placenta incarcerated following partially or completely separated is due to constriction ring (hour-glass construction). This may be due to intravenous ergometrine with the delivery of anterior shoulder, premature attempts to deliver the placenta before it is separated, and unnecessary kneading fiddling of the uterus.
  • Morbid adherent placenta – partial or rarely, complete.

DIAGNOSIS: The diagnosis of retained placenta is made by an arbitrary time spent following delivery of the baby.Whether the placenta is retained with prior separation or not, is evidenced by the presence or absence of the features of placental separation.The hour-glass contraction or the nature of adherent placenta (simple or morbid) can only be diagnosed during manual removal.

DANGERS: The risk involved in prolonged retention of placenta are:

  1.  
  2.  

PERIOD OF WATCHFUL EXPECT ANY:

  • During the period of arbitrary time limit of half an hour, the patient is to be watched carefully for evidence of any bleeding, revealed or concealed and to note the signs of separation of placenta.
  • The bladder should be emptied using a rubber catheter.
  • Any bleeding during the period should be managed as outlined in third stage bleeding.

RETAINED PLACENTA: *Separated * Unseparated *Complicated

Placenta is separated and retained – To express the placenta out by controlled cord traction.

Unseparated retained placenta (apparently uncomplicated) : Manual removal of placenta is to be done under general anaesthesia as described earlier. “

The central point of the above contents in the medical literature is that the major complication arising from the retained placenta is haemorrhage; that shock may also result either due to blood loss or frequent attempts to extract the placenta manually; that the left over placenta may also cause sepsis; and that, in the case of apparently uncomplicated / un-separated retained placenta, manual removal of placenta is to be done under general anaesthesia.

From the other medical literature filed in the form of an Article by WebMd Editorial Contributors under the caption “WHAT IS A RETAINED PLACENTA?”, the following points could be culled out:-

  • The placenta is a temporary organ that grows during pregnancy to filter oxygen, blood and nutrients to the growing baby. Post delivery, usually within 18 to 60 minutes, the mother will also deliver the placenta shortly thereafter.
  • Sometimes all or part of the placenta stays in the womb due to various reasons that include   - not enough contractions, growth of placenta inside the uterus wall, closure of cervix, early delivery, giving birth many times, previous surgery in the uterus, conception by ivf, having a retained placenta in another pregnancy,  and it is called a retained placenta that can cause serious side effects.
  • The common symptom of a retained placenta after birth is sudden blood loss and life-threatening bleeding.
  • At times when most of the placental matter is pushed out, yet, some pieces got stuck inside, that can cause symptoms after a while in the form of blood clots, fever, chills, flu and foul-smelling vaginal discharge.

In the present case, it could not be expected for the mother to deliver the placenta shortly after the birth of the baby since it was not a case of normal delivery but it was through a surgical procedure called C-Section.It is the inherent part of the procedure performed by the 2nd OP to clear the placenta followed by the delivery of the baby. While so, if it is alleged that the placental matter was not removed by the Doctor after the delivery of the baby and in support of such allegation, it is averred and argued that the patient had suffered heavy post-partum bleeding, what needs to be primarily looked into is - whether the patient had indeed suffered such complication and the said aspect is borne out by records.In this regard, the averment made by the complainant, available at para No.11 of the Complaint, runs to the following effect:-

               “ 11. …… But the Opposite Parties failed to clean the uterus and which lead to over bleeding and in view of the gross negligence of the Opposite Parties the complainant’s wife died. …”

Except the above stray averment, there is no emphatic allegations anywhere seen in the whole complaint to the effect that, anytime during the interregnum between 7.20 AM when the patient had delivered the child and 12 Noon when the patient is said to have vomited, she had over-bleeding or excessive post-partum haemorrhage and that either the complainant or the other relatives, who were present there at that time, could notice the same. If really she developed the complication of over bleeding, the same would not have gone unnoticed.Further, it is the case of the 2nd OP that the issue of placental retention would not arise at all in the present instance since her first delivery in the Government Hospital was by way of C-Section and the present delivery was also through LSCS, during which course, after delivery, in the presence of the medical team consisting of the Anesthetist, Child Specialist, etc., she removed the entire placental matter in toto and further, the small placental tissues that got stuck in the previous sutures were also wiped by her with a dry gauze and, in that regard, the members of the Medical Team, who accompanied her during the procedure, have endorsed & affirmed the said factum by giving their respective certificates and the same had already been annexed in her reply notice.It is her further case that, immediately after the death of the patient, she had addressed a letter to the police and the forensic authorities, duly informing the sequence of events and that, despite her repeated requests to the complainant to furnish her with a copy of the post mortem/forensic reports, he never complied with such request.

Be that as it may, on a careful scrutiny of the records, on the one hand, we fail to see that the patient had developed any complication directly connected to placenta retention in the form of profuse bleeding as averred and alleged by the complainant’s side and, on the other hand, we are able to see that the whole allegations of the complainant are rendered a blatant falsehood from the very contents of his own complaint under Ex.A12, hand-written by him to the Inspector of Police, Tirumullaivoyal Police Station, by stating thus:-

  • (24.02.2012) ,d;W fhiy Rkhu; 07.26 kzpf;F mWit rpfpr;ir%yk; ngz; Foe;ij gpwe;jJ. gpwe;jgpd; jhAk; NrAk; eykhf ,Ue;jhu;fs;.   gpd;G Rkhu; 12 kzpmstpy; vdJ kidtp the;jp tUfpwJ vd;W $wpdhu;.  mg;NghJ gzpapy; ,Ue;j lhf;lu; eu;rplk; $wp Crp Nghl;lhu;fs;.  Crp Nghl;l gpwF cly; KOtJk; Ntu;j;J typapy; Jbj;jhu;fs;.  gpwF ngupa kUj;Jtu; te;J ghu;j;Jtpl;L Rkhu; 12.30 kspmstpy; vdJ kidtp ,we;Jtpl;ljhf $wptpl;lhu;fs;.   vdNt vdJ kidtp vjdhy; ,we;jhu; vd;w fhuzk; njupa Ntz;b vdJ kidtpapd; cliy gpNuj gupNrhjid nra;J ey;ylf;fk; nra;a vd;dplk; xg;gilf;FkhW NfhUfpNwd;”.

The English translation of the above passage is –

“ …. that today (24.02.2012) morning, by around 7.30, a female baby was delivered through surgery at 7.30 am.; that, after delivery, both the mother and baby were fine; that thereafter, at around 12 O’ Clock, my wife told that she had vomiting sense and that, after administering an injection by the Duty Doctor/Nurse, she had sweating all over the body and suffered acute pain, whereupon, the Chief Doctor examined and pronounced her dead at 12.30 pm and that, in order to know the cause of the death, I request for doing post-mortem of her body and thereafter, to hand over it for burial rites.”

From the said police complaint lodged by none else than the complainant in his own wordings, it is quite clear that the mother, along with the baby, was fine after the delivery, that she was interacting with him and that, till 12 Noon until she told the complainant that she had vomiting sensation, she did not encounter any other issue, in particular the complication of over bleeding, which is a distinct indicator of placenta retention. It is not the case of the complainant that the problems faced by the patient at 12 Noon in the form of vomiting and convulsions are the complications connected to retained placenta. Further, the details in the form of a complaint/first-hand information under Ex.A12 emanating from the complainant himself only runs sharply contrary to his averments and goes absolutely in line with the version of the 2nd OP to the effect that post-delivery, the patient was well and fine and that she was in the company of her relativesincluding the complainant. Therefore, the contrary allegations made by him to the effect that the relatives were not given access to meet the patient and her medical condition was not made known to them until the 2nd OP declared the patient dead are all contrary to facts and truth.From the very own written complaint of the complainant, it could be easily discerned now that, except the convulsions and seizures developed in the patient after she started vomiting for which she was administered injection-Vomikind at or after 12 Noon, the patient had never shown any sign of haemorrhage per vagina or profuse post-partum bleeding, as falsely stated and projected now by the complainant. At any rate, the police complaint, which is seemed to have been presented by the complainant himself, gives a completely different picture quite contrary to the present allegations & stand that his wife had suffered over bleeding due to retained placenta; as such, he has come to this Commission with a pair of unclean hands carrying malice against the OPs.

Having found so, let us now turn back to the issue pertaining to the final opinion given by the Police Surgeon below the Forensic Report.

From Ex.P17-Post Mortem Certificate, dated 25.02.2012, it is seen that the said Certificate is issued by Dr.R.Selvakumar/Police Surgeon and the relevant entry made by him under the caption “on dissection of uterus” shows that he found TINY BITS OF PLACENTAL TISSUE FOUND ATTACHED TO THE UTERUS.The actual tenor of the said noting, as such, does not lead to any definite conclusion regarding retained placenta. While so, reserving his opinion over the cause of death, he awaited the visceral report from the Forensic Lab and the said Report under Ex.A17, dated 19.03.2012, shows that no poison was detected in any of the visceral items.Below the said forensic report, the said Dr.Selvakumar gives the final opinion in the hand-written form stating that the deceased would appear to have died due to effects of retained placenta.The said opinion, in our considered view, cannot be taken to be a conclusive proof for sustaining the allegations of the complainant regarding placental retention for the reasons that, in the Post Mortem Certificate without final opinion, the noting made by the Police Surgeon was that only tiny bits of placental tissue were found attached to the uterus; while so, when the visceral report was exclusive to the aspect of presence or otherwise of poison in the organs subjected to forensic examination, without mentioning or referring to any further details like the width and weight of the uterus or the placental tissue noted in the first report, it is not known, as to on what basis, he came to the conclusion as if it is a case of whole placental retention.Further, as broadly discussed above, the ground facts as well as the records do not support the case of the complainant originating from the opinion of the Police Surgeon, hence, no importance needs to be attached to the same.It is not out of place to add here that, in the medical literature – V Edition of D.C. Dutta Text Book of Obstetrics – at page No.21, with reference to the term ‘Placenta at Term”, the gross anatomy is detailed in the following manner:-

                              “ The placenta at term is almost a circular disc with a diameter of 15-20 cm and thickness of about 3 cm at its centre. It thins off towards the edge. It feels spongy and weighs about 500 gm, the proportion to the weight of the baby being roughly 1:6 at term and occupies about 30% of the uterine wall. It presents with two surfaces fetal and maternal and a peripheral margin.”

In the light of the anatomy aspect as could be seen from the above text, the final opinion given by the police surgeon, without reference to any further details as to the width and weight of the placenta or placental tissues, being highly doubtful, it is not safe to give any credence to the same having regard to the factual circumstances and the material records that do not support any of the allegations put forth by the complainant.

 

Having discarded the opinion of the Police Surgeon, even otherwise to prove the allegation of medical negligence against the OPs, the complainant could have adduced the expert opinion from his side but he miserably failed to do so.The entire allegations leveled against the OPs by the complainant are enervated by his own complaint lodged with the police and even barring that, on appreciating his case and claim in the light of the other materials on record, we hardly find any reason or ground to sustain the same.In the absence of substantive materials on record as well as medical evidence in the form of expert opinion to clearly indicate any medical negligence, the doctrine of res ipsa loquitur is not attracted here and hence, we have no other option except to dismiss the Complaint as devoid of any merit.

 

11. In the result, the Complaint fails and it is dismissed, however, there shall be no order as to costs.

 

                                    

R VENKATESAPERUMAL                                           R.SUBBIAH, J.

MEMBER                                                                             PRESIDENT.

 

 

LIST OF DOCUMENTS MARKED ON THE SIDE OF THE COMPLAINANT

 

  •                 Date                      Description of Documents

 

  1.  
  •  

Copy of Identity card of the complainant’s wife

  1.  
  1.  

Copy of pay slip of the complainant’s wife

  1.  
  1.  

Copy of the antenantal card issued by the opposite party to the deceased

  1.  
  1.  

Copy of the prescription issued by the 2nd opposite party to complainant

  1.  
  1.  

Copy of Lab Test of the deceased

  1.  
  1.  

Copy of the scan report issued by the 1st opposite party

  1.  
  1.  

Copy of the scan report

  1.  
  1.  

Copy of the scan report issued by the 1st opposite party

  1.  
  1.  

Copy of the case sheet issued by the opposite parties

  1.  
  1.  

Copy of the consent form issued by the 1st opposite party

  1.  
  1.  

Copy of the Death Certificate of the complainant’s wife

  1.  
  1.  

Copy of the letter given by the complainant to T10 Police Station

  1.  
  1.  

Copy of the First Information Report

  1.  
  1.  

Copy of the accident register

  1.  
  1.  

Copy of the letter issued by the opposite parties to the KMC Forensic Department

  1.  
  1.  

Copy of the post mortem certificate issued by the KMC Forensic Department in Tamil Version

  1.  
  1.  

Copy of the post mortem certificate issued by the KMC Forensic Department in English Version

  1.  
  1.  

Copy of the legal heirship certificate

  1.  
  •  

Copy of the legal notice issued by the complainant

  1.  
  1.  

Copy of reply notice given by the 2nd opposite party

  1.  
  1.  

Copy of the detailed reply notice sent by the 2nd opposite party

 

 

LIST OF DOCUMENTS MARKED ON THE SIDE OF THE Ops

 

  •       Date            Description of Documents

 

  1.  
  1.  

Copy of the consent form

  1.  
  •  

Copy of the case sheet

  1.  
  1.  

Copy of the reply notice

 

 

 

 

R.VENKATESAPERUMAL                                        R.SUBBIAH, J.

MEMBER                                                                             PRESIDENT.

 

ISM/TNSCDRC/Chennai/Orders/JULY/2023.

Consumer Court Lawyer

Best Law Firm for all your Consumer Court related cases.

Bhanu Pratap

Featured Recomended
Highly recommended!
5.0 (615)

Bhanu Pratap

Featured Recomended
Highly recommended!

Experties

Consumer Court | Cheque Bounce | Civil Cases | Criminal Cases | Matrimonial Disputes

Phone Number

7982270319

Dedicated team of best lawyers for all your legal queries. Our lawyers can help you for you Consumer Court related cases at very affordable fee.