By Smt. C.S. Sulekha Beevi Complainants who are husband and wife have jointly preferred this complaint alleging medical negligence against opposite parties. Facts:- The complainants have a child, who was aged six years when the first complainant concieved for the second time after long expectations. In the early stage of her pregnancy she consulted Dr. Noorjahan at Kondotty. This doctor opined that the postition of the foetus is complicated and referred her to first opposite party hospital. Thereafter first complainant was under the care and advice of second opposite party doctor who worked in first opposite party hospital. Complainant adhered to the advices given by second opposite party doctor. She approached second opposite party doctor on 19.08.2002 to get herself admitted for the delivery. But the doctor send her back assuring that everything was okay and that she need come only on 23.8.2002. Complainants and relatives were assured by second opposite party that the delivery would be normal. As advised first complainant got admitted in opposite party hospital on 23.08.2002. Second opposite party doctor examined the first complaint and told that the delivery will be due only after 2 or three days or may be even after a week. First complainant told that Dr. Noorjahan had said that the delivery would be on 19.8.2002.Then second opposite party doctor advised to take a scan. Dr. Kunji muhammed attached to first opposite party hospital did the scan. At the time of sean, Dr. Kunhimuhammed had said that the scanning should have been done at an earlier stage. After scanning ,Dr. Kunhimuhammed expressed the opinion that the position of the foetus does not suit for a normal delivery and that caesarian surgery would be required. Complainants conveyed this opinion to second opposite party doctor. But, second opposite party assured that as the first delivery was a normal delivery, this delivery would also be normal and directed first complainant to be taken to the labour room. Second opposite party doctor left for her home. In the labour room the first complainant struggled with unbearable pain. There was no doctor in the labour room and she was attended by untrained nursing staff. They teased her saying that as it is her second delivery, she should undergo labour without complaining. First complainant repeatedly complained of severe pain and her feeling of something untoward was happening . She was not attended properly. Her request to call the doctor was not heeded to by the nurses. Her delivery was much delayed. Opposite parties did not inform her husband and relatives about the situation. She delivered at late night. Due to the delay in delivery the child consumed liquids from inside and died. In the discharge summary it is stated that child died after four hours. The cause of death and treatments given to the child are not mentioned in the discharge summary. That no doctors were present during the delivery. Second Opposite party doctor was summoned after delivery seeing the complication. The first complainant was left unattended for four hours after delivery. Apart from the death of the child the uterus of the first complainant was removed. That complainants were not informed about the surgery that was performed. It was informed only after a few days. That if opposite parties had diagnosed the condition of the uterus ealier, the situation could have been avoided. On seeing delay in delivery second opposite party doctor ought to have performed caesarian. The child as well as the uterus could have been saved. Paediatrician was not present during the time of birth. The child lost its life due to improper treatment. The newborn was a boy. Complainants presently have only a daughter. By removal of uterus, the first complainant has become permanently unable to concieve. Complainants are put to much mental agony and sufferings. After the incident first complainant suffered mental shock and she was treated at MIMS hospital Kozhikode by Dr. Valsa, who is a psychiatrist. She is undergoing treatment even now. Opposite parties did not impart proper care and treatment. Complainants were allured by the advertisements of opposite party hospital regarding facilities and treatments available at the hospital. The acts and omissions on the part of opposite parties amount to deficiency in service. First complainant send a letter on 11.12.2002 requesting opposite party hospital to supply the treatment records. Though opposite party received the letter opposite party did not reply or supply the treatment records. Complainants were then constrained to issue a lawyer notice. Opposite parties received the notice and requested one month's time to send reply. That this is intended to manipulate records and cause delay to the complainants. Hence this complaint alleging negligence and medical deficiency. That even though the loss sustained cannot be calculated in terms of money complainants estimate the same to Rs.2,00,000/-lakhs for loss of child, and Rs. 2,50,000/- for loss of uterus.
First and second opposite parties have filed separated versions. It is stated that first opposite party adopts the contentions submitted in the version filed by second opposite party doctor regarding the treatments given to first complainant at opposite party hospital. That while at opposite party hospital the first complainant was attended by qualified, experienced doctors and well trained nursing staff. No nurses are allowed to mock or laugh at patients. Such allegations are specifically denied. That ultra sound scan was done as per advice of second opposite party doctor. There was no anomaly revealed as per scan report. The scan report is in the possession of complainants. The non-production of the scan report before the Forum indicates suppression of material facts. The allegation that complainants and relatives were not informed about the situation, the complication, the surgery etc is denied. That second opposite party doctor was present in the labour room and the first complainant was closely monitored by second opposite party through out her delivery. More over, another gynaecologist, Dr. Manorama Ramanathan, Dr. P.M.Mohammed Ilyas, Retd Professor of surgery and Dr. Gopinath, M.S, Senior surgeon have attended the first complainant. The duty anaesthesist intubated the baby and informed paediatrician. The baby was transferred to NICU. After delivery there was profuse bleeding which led to subsequent hysterectomy. Complainants and relatives were informed about the surgery and proper consent was taken. The doctors at opposite party hosptial tried their level best to save the life of the baby as well as the uterus of the first complainant. Unfortunately it failed. Post partum haemorrhage is a serious condition and if it is not intervened in time, it may become fatal. Due to timely intervention the life of first complainant was saved. The reason for death of baby is stated in the discharge card. The treatment details were also stated. Opposite parties have not concealed anything. That case sheet pertaining to treatment will not be given to anybody and that first opposite party hospital is not bound to do so. That opposite party is ready and willing to submit the case sheet before the Forum if direced to do so. That complainants did not settle the hospital bill at the time of discharge. Though opposite party send a letter asking to settle the bill, complainants did not turn up to pay the amount. That there is no deficiency. Second opposite party doctor filed a separate version. Denying the averments in para 3 of the complaint it is submitted that first complainant was first seen by second opposite party doctor on 2.8.2002. That on 19.8.2002 she was seen by Dr. Manorama Ramanathan. On 2.8.2002 complainant was examined. She was G2 P1. Her first full term normal delivery was 4 ½ Years back. On enquiry made by opposite party, it was disclosed that her LMP was on 14.11.2001. So her EDD was reckoned as 22.8.2002. Her cycles were irregular. On examination her BP was 110/70 mm Hg vertex was cephalic in presentation and foetal heart was +ve. All necessary investigation's were done and she was advised to come on 19.8.2002. It is incorrect to state that there was complication in the position of foetus. The allegation that second opposite party told the complainants and their relatives that there is no complication at all and that the delivery will be normal delivery is denied. That no doctor can give such assurances. On 19.08.2002 the first complainant was examined and her BP was 110/70 mmHg, the gestation was 36 weeks with cephalic presentation FH+ve, cervix was closed at-3 station. The patient was advised to came for admission on 23/8/2002 or earlier, if she feels pain. On 19.8.2002 the first complainant exhibited no symptoms wanting hospitalisation and so she was send back. There was no delay in hospitalisation in the case of first complainant. On 23.8.2002 she come for admission at 12.45. She was investigated throughly and as per Ultra sound scan report the gestation was 37 weeks. Placenta G II-III, liquor (amniotic fluid) was adequate and the weight was 3.1 Kg. On scrutiny of the scan report this opposite party could not find out any abnormality. On 23/8/2002 this opposite party never sated that the delivery will be due only 3 days or a week later. It is also denied that this opposite party suggested scanning on hearing the opinion of another doctor, who treated the first complainant earlier. Such statement is made only for the purpose of this case. In fact in the Lawyer Notice issued earlier at the instance of the complainants, the date of delivery alleged to be told by Dr. Noorjahan is stated as 19/8/2002 to 23/8/2002. But in the complaint the date of delivery alleged to be told by Dr. Noorjahan is confined to 19/8/02. This twisted versions regarding date of delivery it self makes it clear that the complainants are stating utter lies before the Forum to suit for the occasions. On 23/8/2002 at 03.15 pm the first complainant was taken to the labour room. On examiniation BP was 130/80mmHg, Per abdomen Uterus was not acting, FHS (Feotal Heart Sound) 146/mt. P/V Vertex was-2 station,membrance +, and Cervix dilated 50% pelvis adequate. Induction with cerviprime gel was done. The first complainant was given inj. Ampicillin ATD. Foetal Heart and Uterine contractions were closely monitored in the labour room. At 5.30 PM there was mild pain, BP 130/80 mmHG, uterus acting mildly. FH was good. Soap/Water enema and IV fluids were given. At 8.30 pm BP 120/80 mm Hg, uterus acting, FH good. P/V cervix taken up 3-4cms, membranes absent, +1 station. At 8.45 pm, uterus acting ,FHS good P/V Cervix fully taken up and dilated, +2 station. At 09.05 pm the first complainant delivered with episiotomy, a deeply asphyxiated baby, with thick meconium stained liquor. Immedate resuscitative measures were done. The duty anesthetist intubated the baby. The paediatrician transferred the baby to Neonatal Intensive Care Unit (NICU). The allegation that Dr. Kunhi Mohammed attached to the first Opposite party hospital after scanning the first complainant told that the scanning had to be done at the earlier stage and the position of the foetus had to be ascertained regularly etc.is utter false. The allegations that Dr. Kunhi Mohammed expressed that the position of foetus does not suit for normal delivery and Caesarean Surgery is required and the same was conveyed to this opposite party and at that time this opposite party told that since the first delivery is normal this will also be normal etc. have no nexus with truth. The nursing staff attached to opposite party hospital are well trained and experienced. There was no occassion to mock the complainant. There was no delay in delivery. After delivery the episiotomy was sutured .Bleeding P/V was noticed and suddenly the bleeding became severe. On examination uterus was flabby and atonic immediate measures were taken to control the bleeding, including blood transfusion. The first complainant went in for BP fall, became pale with respiratory distress. The patient was seen by Dr. Manorama, the other Gynaecologist of the hospital. The patient was also seen by Dr. P.M Mohammed Iiyas, M.S.Retired Prof. Of surgery and Dr. Gopinath MS, Senior Surgeon. Since the bleeding was uncontrollable and the condition of the complainant was deteriorating a collective decision was taken to do emergency Hysterectomy to save the life of the patient. Prior to hysterectomy the second complainant and other relatives were informed about the condition of the first complainant. A written informed consent was also obtained. There after under all asceptic precautions with utmost care and caution Hysterectomy was done under G/A by the second opposite party along with Dr. Gopinath. Since there was b leeding from pedicle, internal iliac artery ligation was done. Post operatively appropriate medicines were given and the patient was closely monitored. The Post operative period was uneventful and the patient was discharged on 03/9/2002. The baby inspite of the best efforts by the paediatrician expired at 01.09 AM on 24/8/2002. Hence the allegation contrary to the above said facts are not true and hence denied. Second opposite party was present at the time of delivery and other doctors have also attended the complainant and the baby. At the time of discharge opposite parties, have issued discharge card. All necessary details are stated in the discharge card. Complainants did not settle the hospital bill even though letter was send asking to pay the amount. In-patient records are usually kept in the hospital for reference. Utmost care and caution was taken in treatment. Complainants were informed about surgery and seriousness of the situation. That father of complainant and her brother were explained about the complications and the nature of surgery performed. Proper consent was obtained from P.Zubair and Alikutty who were present in the hospital. The contention that if caesarian was performed the child as well as the uterus could be saved is incorrect. That there was no indication to perform caesarian. Atomic PPH can occur after caesarian opoeration also. Life of first complainant was saved only by timely invertention of doing the surgery. The alleged psychic problem suffered by first complainant has no relevance to this case. Detailed reply was issued to the lawyer notice issued by complainants. That opposite party has nothing to hide and the allegation that there is chance to manipulate case records is denied. That there is no deficiency on the part of second opposite party doctor. That complainants are not entitled to any reliefs.
Evidence consists of the oral evidence of first and second complainants who were examined as Pw1 and Pw3 respectively. Pw2 is the expert witness examined on behalf of complainant. Exts A1 to Ext A7 marked for complainant. Second opposite party was examined as Dw1 and first opposite party was examined as Dw2. Ext B1 maarked for opposite parties. Points for consideration (i) Whether opposite parties are deficient in service (ii) If so, reliefs and costs. 6. Point (i) The allegations of negligence assailed by the complainant as against opposite parties can be summed up as under:
(a) That Dr. Noorjahan who had earlier examined the first complainantas well as Dr. Kunhimuhammed who had done the scan on 23.8.2002 had expressed opinion that the lie of the foetus does not suit for normal delivery and that caesarian is required. Even though these opinions were conveyed to second opposite party by the complainants, the doctor failed to adopt caesarian for delivery of child. Due to this, the delivery was delayed and child died. The uterus of the first complainant had to be removed. That if second opposite party doctor had adopted caesarian surgery all mishaps, could have been avoided. Not doing caesarian and adhereing to normal delivery even though there was indication of complication is negligence on the part of second opposite party doctor. (b) That second opposite party doctor induced labour unnecessarily and this resulted in the uterine atony. The gestational age of the foetus as on the date of admission (23.8.2002) was only 37 weeks. Full gestational age is 40 weeks. Opposite party doctor induced labour on 23.8.2002 prior to full gestational age, unwantedly, without indications and this has caused bleeding leading to post partum haemorrhage. If labour was not induced, PPH would not happen and hysterectomy could have been avoided.
(c)The foetal Heart Sound (F.H.S) of the foetus was not recorded after 8.45 pm. Delivery took place at 9.05 pm. The child was asphyxiated due to liqour aspiration. If F.H.S was recorded between 8.45 to 9.05 pm the foetal distress could have been be detected and the child could be saved with timely intervention. Not recording F.H.S between 8.45 to 9.05 pm is negligence.
(d) That there were no doctors to attend the first complainant during her delivery. She was left unattended for four hour after delivery. (e) Opposite parties did not inform the complainants about the complexity and the nature of the surgery. That proper consent was not obtained for doing hysterectomy. (f) The child died after 4 hours at opposite party hospital. The treatment records produced by opposite parties do not show anything about the treatment given to the child till its death. Discharge card also does not state about the treatment given to the child. That not maintaining proper treatment records is negligence. (g) That opposite parties did not supply the copy of treatment records even though first complainant send a written letter requesting for the same. Non supply of treatment records is deficiency.
Denying the allegations of negligence, the defence raised by opposite parties is as under: (a) That first complainant was admitted in opposite party hospital on 23.8.2002 for safe confinement. She was previously seen by second opposite party doctor on 2.8.2002. On 19.8.2002 she was seen by Dr. Manorama Ramanadhan at opposite party hospital who instructed her to come for admission on 23.8.2002. On 2.8.2002 and 23.8.2002 second opposite party doctor examined the complainant. Second opposite party doctor did not find any indication to conduct caesarian operation. By external examination and USG second opposite party doctor was convinced that the lie and presentation of the foetus was normal. The first delivery of the complainant was a normal delivery. That Dr. Kunhimuhammed who did the scan has not expressed opinion that the position of the foetus is unsuited for normal delivery. There is nothing in the scan report indicating need for caesarian surgery. Second opposite party adopted normal delivery as there were no indications to adopt caesarian section. There was no delay in delivery. Labour pain started at 5.30 pm and delivery occured at 9.05 pm which is normal time taken for delivery. The complications to the child arose in the process of delivery. Membrane ruptured at 8.30 pm. The liquor was then clear. Till delivery there was no indication of foetal distress. Child died due to liqour aspiration during the birth process and it is an accepted complication. Bleeding through vagina started after delivery. It was managed by vaginal plugging and ligation. As the bleeding continued emergency hysterectomy of removing the uterus was done as a life saving measure. These are accepted complications in delivery. There were no indications to adopt caesarian section and that second opposite party has acted in accordance with medical protocol.
(b) Labour was not induced unwantedly. After admitting the patient on 23.8.02 labour was induced with cerviprime gel. The cervix was one finger loose on 23.8.2002 which indicated symptom of immediate labour. So induction of labour was done though the gestational age was 37 weeks. The contention that uterine atony occured due to induction of labour when it was unwanted is denied as incorrect by opposite party. That uterine atony can happen when labour is not induced also.
(c) The F.H.S of the baby was continuously ascertained and recorded till 8.45 pm. It was recorded in the nurses chart. After 8.45 pm foetal heart was ascertained. It was not recorded in the case sheet as the nurses and second opposite party doctor were with the patient. The asphyxia due to liquour aspiration was an intra partum event. There was no variation in the foetal heart till delivery indicating foctal distress (d) Proper consent for doing hysterectomy was obtained. Complainant and relatives were informed about the complication and the nature of surgery. Hysterectomy was done as a life saving measure. (e) First complainant was not left unattended. Second Opposite party was present during delivery. Second Opposite party was assisted by trained nurses. Besides, Dr. Mnaorama, Dr. Ilyas and Dr. Gopinath have examined and attended the patient after delivery. Hystereotomy was done at 11.15 pm and the contention that first complainant was left unattended for four hours after delivery is totally false. (f) Child died due to birth asphyxia. Immediate resusciative measures though done failed. Child was transferred to NICU. Dr. Rajeev, the paediatrician was called and baby was seen by him. Cause of death was stated in the discharge card. Treatments given to the child is stated in the case sheet of the first complainant. (g) In patient records were not supplied to the complainant though a written request was made by her because such records are property of the hospital to be maintained for future reference. Moreover, the complainants did not settle the bill. 8. On the above submissions, the foremost point that arises for analysation is whether there was any indication to do caesarian surgery and whether second opposite party doctor has overstepped these indications and adopted normal delivery; whether this act of second opposite party doctor has caused the death of the child and removal of uterus of first complainant. 9. According to complainant Dr. Noorjahan who treated her earlier and Dr. Kunnimuhammed who did the scan on 23.8.2002 had expressed opinion that the position of the foetus is complicated and that caesarian is required. Ext A5 is the prescription issued by Dr. Noorjahan. It shows that first complainant has consulted Dr. Noorjahan on 26.2.2002, 22.4.2002,22.5.2002,20.6.2002,2.7.2002 and 24.7.2002. There is nothing in Ext A5 which shows that Dr. Noorjahan noted the position of the foectus to be complicated. Dr. Noorjahan has not been examined as a witness. Ext A4 is the scan report issued by Dr. Kunhimuhammed which was taken on 23.8.2002, ie, the date of delivery. In Ext A4 the lie of the foetus is noted as longitudinal with cephalic presentation. This is normal . It is stated in the report that no abnormalities are noted. Dr. Kunnimuhammed was examined as Pw2. He denied the contention of the complainants that after taking scan he expressed opinion that caesarian will be required. His evidence in chief examination is as under: "As per Ext A4 scan report the foetus was 37 weeks and 5 days of gestational age. The position of the foetus was longitudinal, cephalic presentation. The weight approximately was 3156 gm. I would not agree to the suggestion that there was a ny anticiaption of anomalies to the foctus. I have stated in A4 that 'anomaties cannot be ruled out'. However there were no gross anomalies. I do not agree that I had advised the complainant to undergo caesaerian section. I do not agree to the suggestion that suppose caesaerian section was conducted after my scan report the foetus would have survived because I cannot predict. The possibility of survival of the baby after caesaerian is equal to that in case of normal delivery". In cross PW2 has deposed as under: "I am an anaesthesiologist and I have obtained training and experience in scanning. I am in the field of medical profession since 1988. I have experience as anaesthegiologist from 1996 onwards. Also in scanning from 1996. I have attended more than 30,000/- surgeries. I have attended about 10,000 surgeries related to pregnancies. It is correct to say that as per Ext.A4 scan report the foetal presentation is cephalic. Cephalic presentation is normal presentation . In the report it is stated as NAD which means 'no Abnormalities Detected." "Atonic PPH is an accepted complication of delivery. I agree that this can occur to any woman during labour as well as in caesaerian section. It is not predictable." 10. The above evidence of PW2, together with Ext A4 and Ext A5 contradicts the case of the complainants that the position of the foetus was complicated, indicating the need for caesarian delivery. Ext A5 scan report taken on 23.8.2002 clinchingly establishes that there were no indications to adopt caesarian delivery. The First delivery of the complainant was a normal delivery. No problems were revealed by the scan report. The weight of the baby was only 3.1 kg which is considered as a small baby. Pelvis was adequate these factors only point that normal delivery can be adopted. There were no indications necessitating a caesarian section. Further second opposite party was consulted by the complainant only in the month of her delivery. Prior to this the complnant has consulted Dr. Noorjahan and scan was also done. On 19.8.2002 she was examined by Dr. Manorama. Bu these aspects are not disclosed in the complaint. The contention of the complainants that the dealth of the child and removal of the uterus happened due to the omission on the part of second opposite party doctor to adopt caesarian section over stepping the indications of complication in the position of the foetus stands unproved. So on this count we cannot find any negligence on the part of second opposite party doctor. 11. Another arguement put forward on the side of the complainant though not averred in the complaint is that second oppposite party unnecessarily induced labour and this led to uterine atony. On 23.8.2002 the gestational age of the foetus was 37 weeks. The gestational age has to be 40 weeks to be a full term baby. It is alleged that by interfering with the pregnancy before reaching full term, second opposite party committed negligence which has resulted in bleeding and uterine atomy. 12. Against this it is submitted by opposite party that labour was induced on 23.8.2002 after admission of the patient as there was immediate symptoms of labour. The cervix was one finger loose and so second opposite party opted to induce labour. Though the baby is preterin the gestational age being 37 weeks, it was not wrong, to induce labour. It is further submitted that induction of labour is not relevant to the cause of uterine atony. That situation of bleeding and PPH can occur in delivery which is not induced also. On perusal Ext B1 case sheet it is seen noted that on 23.8.2002 cervix was one finger loose. The evidence of Dw1 in this regard is as under: " "The full term gestational age is 40 weeks. I agree that delivery before 37 weeks is considered as a preterm baby. Dr. Manorama suggested to get admitted on 23rd. So the patient has come on 23rd. It is correct that I saw the patient on 23.8.200. It is correct that on examination I found that the gestational age is 37 weeks. In USG also the gestational age was 37 weeks. When I examined the patient on 23.8.2002 there was symptom of immediate delivery because the cervix was dilated. Witness peruses Ex.B1 and adds. It was one finger dilation. When cervix is one finger loose it means that the patient has started labour. I used cervi prime gel to induce labour. I was present with the patient from 3.15 onwards to induce labour" "The medicine used for induction of labour,Oxytocin is intended to increase oxytocin level" "I do not fully agree to the suggestion that uterus atony is more prevalent in the case of induced labour because it can happen in normal delivery also. I do not know to commend to the suggestion that women whose labour is induced has an increased incidence of chorioamniophities" " I deny the suggestion that uterine atony of the patient was caused due to the induction of labour, when it was not needed"
13. The above evidence of Dw1 together with Ext B1 establishes that induction of labour was not unwanted and was not the reason for uterine atony. Though the counsel for complainant argued that as per medical literature, uterine atony is more prevelant in induced labour, no such literature is placed before us. We therefore cannot uphold the arguements of the counsel for complainant in this regard. We find no liability on the part of second opposite party doctor for inducing labour.
14. It is further alleged by the complainants that second opposite party doctor failed to record the F.H.S from 8.45 pm till delivery (9.05 pm). This was the crucial time and if F.H.S had been recorded between 8.45 to 9.05 pm the baby could have been saved. Countering this allegation, it is submitted on behalf of opposite parties that F.H.S was monitored and recorded in the nurses chart upto 8.45 pm. That after 8.45 pm, F.H.S was ascertained by second Opposite party who was present near the patient till delivery. It was not recorded by the nurses in the nurses chart because the nurses were with second opposite party doctor assisting the delivery. It is also the case of second opposite party doctor that the F.H.S was normal and there was no indication of foctal distress till delivery. The liqour aspiration and foetal distress occuired during the birth process. It was an intra partum event.
15.On scrutiny of Ext B1 case sheet it is seen that in the nurses chart F.H.S is recorded from 3 pm till 8.45 pm. Up to 8.45 pm the F.H.S does not show any dip indicating distress. F.H.S seen to be within is normal limits. The delivery time is 9.05 pm. During this 15 minutes the birth/ delivery has taken place. The time for the process of birth may vary depending upon the co-operation of the mother and other factors. In this crucial time the doctor and nurses concentrates on assisting the mother with the labour. Even the delivery notes are entered only after the delivery. Though complainant says that second opposite party doctor was not present during delivery we cannot give much credence to this contention. She has suppressed that on 19.8.2002 she was seen by Dr. Manorama and has twisted the consultation done on 19.8.2002 to suit her case. Complainant also did not disclose the consultation done with second opposite party doctor on 2.8.2002, and also the scan done earlier as per advice of Dr. Noorjahan. The scan done earlier is material considering the contentions put for ward by complainant. But she averred that Dr. Knnimuhammed stated that scan ought to have been taken at earlier stage. Such statements have cast a doubt on her credibility .Dw1 has categorically deposed that she was present in the labour room and has ascertained the F.H.S after 8045 pm. That F.H.S and other parameters were normal. That the distress has occured during the process of birth . The non entering of F.H.S in case sheet for a short time from 8.45 pm to 9.05 pm is no evidence that F.H.S was not ascertained. The evidence of Dw1 in this regard is as follows: "Myself and nurses have checked the F.H.S. In page 25 of Ext B1 the nurses chart will show record of FHS. I have not separately noted the FHS because the nurses chart it is recorded. All through at 3.15 pm , 5.30 pm and 8.45 pm the FHS was found normal. During contrations also there was no variability in the FHS. The asphyxia was an intrapartum event. There was no placenta previa. There was no undue delay in delivery. There was no cord prolapse, true-knot,short cord. I do not agree to the suggestion that due to the compression of the head on the pelvis of the another asphyxia can happen. I do not agree to the suggestion that due to non- judicious administration of mother it can result asphyxia of the child in the womb because usually we do not give such medicines in the labour room. Meconium aspiraton is the only reason in this case for asphyxia. Foctal distress means FHS is less than 100or more than 140. In the labour room we do not monitor foetal oxygen saturation". "I agree that a healthy foetus can withstand distress in labour with in physiological limits. It is correct that FHS has to be recorded every 30 minutes and in second stage of labour it has to be ascertained every 5 minutes. I agree that after 8.45 the patient was in second stage of labour. I do not agree that not recording the FHS after 8.45 is negligence because. I was standing with the patient. I cannot agree with the suggestion that if there is inherent defect of foetus there will be foetal distress because the foetal distress will be manisfested only after cutting the cord. I agree that presence of meconium in liquour is a presence of foetal distress. It is correct that presence of meconium in liquours of non assuring foetal heart rate necessitates urgent intervention. The membrane ruptured at 8.30 pm. At that time the amniotic fluid was found clear. It is correct that there was no chance of meconuin aspiration till 8.30 pm. It is correct that at 9.05 when baby was born there was thick stain in meconium. Such staining can happen at the time of birth. If there is foctal distress we undertake active management of labour, like instrumental delivery, administration of 1fluid dextrose to the mother, if it fails we resort to caesarian". 16. The above evidence of Dw1 leads us to conclude that the meconium staining in liqour was found by the doctor only after delivery and that it has happened during birth . There is no expert evidence to rebut that such staining cannot happen during birth process. Though second opposite party was cross examined no dent has couched in her evidence in this regard. Therfore the arguement that if F.H.S was recorded after 8.45 pm the child could have been saved is not tenable or acceptable. 17. Complainants are also aggreieved that the first complainant was not attended by any doctors in the labour room and that she was left unattended for 4 hours after delivery. Ext B1 case sheet shows that second opposite party doctor was present during the delivery. Though complainants allege that the case sheet is manipulated, the complainants have failed to specifically point out any aspect to substantiate their contention of manipulation in case sheet. No challenges are made in this regard. There is nothing putforward to disbelieve the genuineness of Ext B1 case sheet. It is seen from Ext B1 that first complainant was attended by Dr. Manorama, Dr. Gopinath, Dr. Ilyas and Dr. Najeeb. The surgery was done at 11.15 pm. Prior to surgery blood was transfused. It is seen entered in Ext B1 that the second complainant(husband) was informed about the need for blood. Several donors are seen to have donated blood. By 9.30 pm 10 units of blood was cross matched and given to the complainant. After transfusion and vaginal plugging the surgery to remove the uterus was done at 11.15 pm. So the contention of the complainant that she was left unattended during the delivery and for four hours after delivery is not believable . 18. The counsel for complainants vehemently urged that opposite parties did not obtain proper consent before doing hysterectemy and that it is gross deficiency. Relying upon the consent letter which is part of Ext B1 case sheet it is submitted by the counsel for complainants that the consent letter was signed by relatives of the complainants and not by the complainants. That consent obtained from relatives is not proper consent. On perusal of the consent letter it is a handwritten consent letter which appears to be copied in verbatim from a printed form. It is see signed by Zubair and Alavikutty. Pw3 has deposed that Zubair is his fathers brother and Alavikutty is his brother. Much arguement was advanced on behalf of the complainants basing upon the signatories in the consent letter and their relationship with the first complainant. It is also alleged that the last sentence in the consent letter which states to have given consent for doing hysterectory is an addition made later. Before entering into the dispute whether the consent letter is proper or not we think that it is necessary to examine whether obtaining consent was inevitable in the present case. The surgery of removing the uterus was not an elective surgery done as treatment of an ailment. It was done as a life saving measure. It is not disputed that hysterectemy is a management to deal with PPH. As per Ext B1 there was continued bleeding per vagina after delivery. Several medications are seen given at 9.10 pm,9.20 pm and 9.30 pm. At 9.45 pm it is noted as ' patient still bleeding'. In between blood was given. At 10.15 patient developed respiratory distress. She was given oxygen and further blood. She was seen by other expert surgeons and hysterectomy was dicided. Condition explained to bystanders. Consent given by relative. Documents reveal that opposite party performed hysterectomy to stop bleeding and to save the loss of life. Every doctor has an obligation to extend his service for protecting life. This obligation is total absolute and paramount. The duty in medical profession is coupled with human instinct to save life and needs no code of ethics or regulation to manage the life of a dying patient. It has been observed by the Apex court that in emergency situations consent is not inevitable. Moreover, in this case the complainant got admitted in opposite party hospital for delivery. There is implied consent of submitting herself to the treatment given in regard to delivery. This implied consent extends to the emergency situation that arose in connection with the delivery. In our view there is no lack of consent even if the complainants (husband &wife) have not signed in the consent letter. Counsel for complainant relied upon the decisions rendered in Samira Kohli Vs Prabha Manchanda(Dr) and another 2008 (1) CPJ 56 SC and Ramgopal. Varshney Vs Lasor sight India Pvt. Ltd and another 2009 (1)CPJ 23(NC). In our opinion the facts of the present case do not fit for application of the principles laid in the above judgments. If second opposite party doctor waits for the first complainant to be fully conscious and alert to obtain consent, she may succumb to the bleeding. Human life has to be given prime importance and not procedural formalities. Nobody need consent to save life. For these reasons we hold that there was no lack of consent to do hysterectomy and that there is no deficiency on this count. 20. It is the case of complainants that opposite parties did not maintain proper treatment records for the treatments given to the child after birth. Opposite parties contend that the treatments given to the child are noted in Ext B1 case sheet of the mother and that this can be considered as the treatment records of the child. On perusal of Ext B1 it is seen noted at 9.05 pm as Baby deeply asphyxiated at birth, with thick meconium stained liquour, baby pale. Brachycardia suction +O2 given injection given. Ampubag given . Immediately called Dr. Najeeb, Endo tracheal intubation given call given to paediatrician urgently. Baby immediately transferred to NICU. In Ext A1 discharge card it is stated as 'Baby cried soon, but gone for secondary apnoe and resucitation done failed. Baby dead after 4 hours'.It is correct that Ext B1 or Ext A1 does not show what are the treatments given to the baby after shifting the baby to NICU. Though opposite parties contend that the baby was seen by paediatrician and shifted to NICU there are no records to show the treatments and management done in NICU. The paediatrician has not been examined. Opposite parties are bound to record the physical condition of the baby after it was shifted to NICU. It may be true that the baby was deeply asphyxiated and was born in a critical condition of health. But if the baby cried soon after birth and died only after 4 hours then the treatments given till it's death gains significnace. There are no records to show which doctor declared the baby as dead. After birth the baby acquires rights separate from it's, mother to be cared and protected at the hospital. Lack of treatment records masks the events the baby had to pass through at the hospital before its 'death'. Not maintaining proper records for treating a baby for 4 hours is gross deficiency. Such negligence cannot be allowed to recurr. Second opposite party has transferred the baby to NICU. Being a gynaecologist her duty is over. First opposite party hospital contends that the baby was thereafter cared by paediatrician. Exact time of death of the baby and the physical condition after it's admission in NICU are not stated anywhere. It is the duty of first opposite party hospital to maintain proper treatment records. Breach of duty is obvious . On this ground we find first opposite party hospital liable for deficiency.
21. The complainants are also aggrieved that first opposite party hospital did not supply treatment records even though they send a written request for the same. First opposite party hospital admits recieving the request to supply case sheet. It is submitted that the case records were not supplied because it is kept in the hospital for future reference. We are not inclined to accept this submission. As per regulation 1.3 of the Indian Medical Council (Professional conduct, Etiquetter & Ethics). Regulation 2002 which came in to force on 6.4.2002 every hospital is bound to supply case records on recieving application. It was submitted on behalf of opposite parties that complainants did not settle the bill. Even if the bills remain unsettled the hospital cannot exercises lien over the records of treatment. It is high time that hospitals adopted the practice to supply medical records when a request is made for the same . We find first oppoosite party deficient in service for non supply of treatment records. 22. A medical man rendering professional service is liable for negligence if he falls short of the standard of reasonably skilled medical person in the field. Having considered the matter in entirety we do not find any deficiency in service by the treating doctor, so far as it relates to the treatment rendered by her. But we consider that there is deficiency on the part of first opposite party in not mainting proper records for the treatment given to the child and not supplying treatment records even after recieving written request. We therefore find first opposite party deficient in service. Second oppostie party is exonerated from liability. 23. Point (ii) In our view the complainants are to be compensated for the deficiency meted by them. It is to be born in mind that the child was born deeply asphyxiated. Complainants have not paid the hospital bill. We consider that an amount of Rs. 25,000/- for not maintaining treatment records of the child and Rs. 10,000/- for non supply of treatment records would meet the ends of justice. Complainants are also entitled to Rs. 2000/- towards cost of this proceedings. All other claims disallowed. We fix the liability upon first opposite party hospital.
24. In the result we partly allow the complaint and order first opposite party hospital to pay to the first and second complainants jointly a sum of Rs. 35,000/- as compensation together with costs of Rs. 2000/- within one month from the date of recieving copy of this order.
Dated this 11th day of October, 2010.
C.S. SULEKHA BEEVI, PRESIDENT MOHAMMED MUSTAFA KOOTHRADAN,MEMBER E. AYISHAKUTTY, MEMBER APPENDIX Witness examined on the side of the complainant : Pw1 to Pw3 Pw1 : Smt. Fathima Pw2 : Dr. Kunhimuhammed Pw3 :Sri. Shahul Hameed Documents marked on the side of the complainant : Ext.A1 to Ext. A7 Ext.A1 :True copy of letter given to opposite party from complainant Ext.A2 :Registered notice issued by Advocate M. Asokan to opposite parties on behalf of complainants. Ext. A3 :Photocopy of Discharge summary Ext.A4 :True copy of Scan report. Ext.A5 : prescription issued by Dr. Noorjahan to first complainant Ext.A6 :True copy of Ration Card. Ext.A7 : True copy of Marriage Certificate. Witness examined on the side of the opposite parties : Dw1 to Dw2 Dw1 : Dr. Lisie Varghees Dw2 :Dr. Moideen Kutty Documents marked on the side of the opposite parties : Ext. B1 Ext.B1 : Original copy of case sheet of opposite party hospital.. C.S. SULEKHA BEEVI, PRESIDENT MOHAMMED MUSTAFA KOOTHRADAN MEMBER E. AYISHAKUTTY, MEMBER
| | [HONOURABLE MR. MOHAMMED MUSTAFA KOOTHRADAN] Member[HONOURABLE MRS. C.S. SULEKHA BEEVI] PRESIDENT[HONOURABLE MS. E. AYISHAKUTTY] Member | | 
