DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, PALAKKAD

Dated this the 31^st day of December, 2009.

Present : Smt. Seena.H (President)

: Smt. Preetha.G. Nair (Member)

: Smt. Bhanumathi.A.K. (Member)

C.C.No.115/2007

Smt. Savithri

W/o. Gangadharan

Thazhath House

Kannanore Post

Coyalmannam, Alathur Taluk

Palakkad. - Complainant

(Adv. T.V. Sudarsh )

V/s

1. The Managing Director

Palakkad District Co-operative Hospital

& Research Centre Ltd, No.P.878

Court Road,

Palakkad – 678 001.

(Adv.R.Udayakumar)

2. Dr. C.K. Lathika, MBBS

DGO

Thottungal

Palakkad

(Adv.V.K. Venugopalan)

3. United India Insurance Co Ltd

Palakkad Branch - Opposite parties

(Adv.C. Mohanram)

O R D E R

By Smt. Seena.H, President

Case of the complainant

The case of the complainant is that complainant was the patient of the 2^nd opposite party in connection with her second pregnancy. Though on checkup, date of delivery was suggested by the 2^nd opposite party as 23/02/2007, it was also suggested that the complainant need admit in the hospital only on pain. Complainant was admitted on 27/02/2007. On 27/02/2007, she felt only intermittent pain but the next day ie, on 28/02/2007, she felt pain and uneasiness from morning itself. Doctor examined her 3 times

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before 1.30 P M and nothing was informed. After 2 P M she felt severe pain and uneasiness and since the pain was intolerable, the husband of the complainant informed the staff of 1^st opposite party hospital. But there was no response. In between 2 P M and 10.30 P M, many times staff of 1^st opposite party was informed about the condition of the complainant, but they took her to labour room only at 11 P M. From labour room, it was informed by the 2^nd opposite party that the matter is complicated and suggested an urgent operation. At about 2 A M on 01/03/2007 it was further informed that a male baby was born and the baby is dead. According to the complainant, the death of the baby was due to the delay in conducting the operation and also due to the lack of proper care and attention and treatment to the complainant. The death of the baby happened only due to the negligence of duty on the part of the staff of the 1^st opposite party hospital and 2^nd opposite party Doctor. Complainant was in ICU following the operation for 3 days. Complainant spent an amount of Rs.20,000/- including the hospital expenses and now claims an amount of Rs.1,50,000/- as compensation.

The version of opposite parties is as follows.

1^st opposite party denied the entire allegations levelled against the hospital. The say of the complainant that the duty nurses of the 1^st opposite party hospital has not responded when the husband of the complainant informed about the pain is false. 1^st opposite party denies the allegation of the complainant that the demise of the petitioners new born child happened only due to the negligence of duty on the part of 1^st opposite party and negligence of 2^nd opposite party. According to the 1^st opposite party there is no negligence or lack of duty to take care on the part of opposite parties.

According to the 2^nd opposite party, when she was working in Palat Memorial Hospital, Palakkad, complainant and her husband were working as Nursing Assistant and Watchman in the same hospital. Because of that acquaintance they used to consult 2^nd opposite party whenever medical problems arose. Likewise regular anti-natal checkup of the complainant was conducted by 2^nd opposite party free of cost at the residence of 2^nd opposite party. She got admitted for delivery in the 1^st opposite party hospital. When the matter was

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informed by the husband of the complainant, she had visited the 1^st opposite party hospital as he worked there previously and with their permission did all the needful to the complainant. 2^nd opposite party submitted that she was not an employee under 1^st opposite party at the relevant time and it was not as per the advise of the complainant that the complainant got admitted to the 1^st opposite party hospital. According to 2^nd opposite party, it was the fourth pregnancy of the complainant. She had history of undergoing two abortions and has a living child. Her expected date of confinement (EDC) was 27/02/2007. On examination her uterus was found to be of full term size, with vertex presentation. Her general condition was good. She had no labour pain. Per vaginum examination revealed that the cervix was not taken up, as was admitting only tip of finger and head was at 3 station. Necessary medication was given. Caster oil was given at night. The duty staff were instructed to monitor the foetal heart sounds and uterine contraction if any at regular interval by the doctor on duty. They were also instructed to inform her if there was any development. Next day morning ie, on 28/02/2007, there was no pain. 2^nd opposite party and duty staff had repeatedly examined her. Same day evening she complained of mild pain. The duty staff had repeatedly monitored and reported the progress to the Gynaecologist on duty.

The labour pain became more severe at around 10.30 P M following leaking per vagina. She was immediately shifted to the labour room and informed 2^nd opposite party immediately. 2^nd opposite party rushed to the labour room at once. The patient suddenly developed severe sweating and breathlessness. There was sudden fall in blood pressure and tachycardia (increased heart rate). She also became tachy pnoeic (increased respiratory rate) dyspnoeic (difficulty in breathing) and restless. She was irritable and there was swelling and redness all over the body. Immediate resuscitation measures were started. Cardiotochography was advised which showed signs of foetal distress. Since foetal heart rate showed variations it was decided to do an emergency caesarean and the anaesthetiast Dr.M.K. Govindan and Paediatrician Dr. Naveen Sivadas were informed. After taking an informed written consent and after explaining the condition of the patient and the possible complication that could probably develop, patient was taken up for surgery. Following the caesarean section, a deeply asphyxiated male baby was extracted and the baby was

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handed over to the Pediatrician who was present in the operation theatre itself. The baby was immediately shifted to NICU. Despite the sincere efforts of the Pediatrician the baby died after about four hours. Complainant was further treated in ICU and was discharged on 6^th post operative day.

According to the 2^nd opposite party, patient developed mild pain in the evening only. The patient and the FHS(Foetal Heart Sound) were being regularly monitored and 2^nd opposite party was also informed about the same. It was only at 10.30 P M, pain became more severe and the patient was shifted to the labour room. 2^nd opposite party also reached the hospital at once.

2^nd opposite party also denies the allegation of the complainant that the husband of the complainant was informed about the death of the male baby at 2 A M. According to 2^nd opposite party, the birth was informed at 11.30 P M. He was well informed about the conditions of the baby and the effort being made by the Pediatrician to resuscitate the asphyxiated baby. It was at 3.45 A M that the husband of the complainant was informed about the death of the baby.

According to the opposite party, the allegation of the complainant that the demise of the complainant's new born baby was due to the negligence on the part of 2^nd opposite party and the staff of 1^st opposite party is false and baseless. Despite all care taken by the opposite parties, the patients developed amniotic fluid embolism, which is one of the dreaded complications of labour which can never be predicted or prevented. Amniotic fluid embolism is a complex disorder characterized by the abrupt onset of hypotension, hypoxis and consumptive coagulapathy. There are great individual variations in its clinical manifestations varying from mild anaphylactic reaction to severe reactions culminating in death.

In amniotic fluid embolism, the amniotic fluid enters the circulation as a result of a breach in the physiological barrier that normally exists between the maternal and foetal compartments resulting in the maternal exposure to various foetal elements. This may occur during labour or normal delivery and even during caesarean. In most cases, these events are annocuous. However in certain women, such exposure initiates a complex series

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of reactions mimicking those seen in human anaphylaxis causing the above said complications. This syndrome is uncommon in an absolute sense, however it is a common cause of maternal death. Classically a woman in the late stages of labour and immediate post partum begins gasping for air and then rapidly suffers seizure or cardio respiratory arrest resulting in death. As a result of amniotic fluid embolism there occurs uterine hypertonicity along with cardio vascular collapse. Indeed uterine blood flow ceases completely when intrauterine pressure exceeds 30 to 40 mm Hg. As a result of the uterine hypertonicity baby developed severe hypoxia. This resulted in the baby being asphyxiated within the uterus itself and finally ending in death.

2^nd opposite party denies the say of the complainant that she has not conducted the operation in time. According to 2^nd opposite party, caesarean section is always conducted whenever there is an indication for it and it is never done unnecessarily. In the case of the complainant, her previous delivery was normal. During this particular pregnancy her anti-natal period was uneventful. All her parameters and that of foetus were within normal limits. Her pelvic dimensions were adequate. Even at the time of admission no abnormality was detected. The patient developed mild labour pain since 28/02/07 evening. The labour was progressing normally. Hence there was no indication for an elective LSCS. As soon as an abnormality was noted in the patients condition and foetal distress was seen, it was decided to do an emergency LSCS. Amniotic fluid embolism as mentioned above is a rare but dreaded complication. It can never be predicted or prevented. It was due to the proper care and attention rendered timely to the complainant which could save her life.

3^rd opposite party filed version in tune with 1^st opposite party and 2^nd opposite party.

Complainant filed affidavit. Exhibit A1 to A5 marked on the side of the complainant. Complainant was cross examined as PW1. Witness on the side of complainant was examined as PW2.

Except 2^nd opposite party, other opposite parties has not filed any affidavit. Exhibit B1 series marked on the side of 2^nd opposite party.

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Now the issues for consideration are:

1. Whether there is any deficiency in service on the part of opposite parties and

2. If so, what is the reliefs and cost complainant is entitled to?

Issue No.1

The specific case of the complainant is that the death of the new born baby of the complainant occurred due to the delay in conducting caesarean by the concerned doctor and also due to negligence of the hospital staff in not attending the patient in time when she complained of pain.

Opposite parties 1 & 2 on the other hand contented that there was no negligence or delay in attending the patient or providing treatment. The death of the child was due to the phenomenon known as amniotic fluid embolism which is a complication which cannot be predicted earlier.

We heard the learned counsels for all the parties and has gone minutely every evidence on record.

On going through Exhibit A1 series lawyer notice dated 07/05/2007 complainant has stated that severe pain was developed at 11 P M on 28/02/07. But in the complaint it is stated that she felt severe pain and uneasiness from morning itself and she was examined by 2^nd opposite party on these occasion and after 2 P M she felt severe pain and it was informed to the duty nurses. Further there is no case of non-attendance of the 1^st opposite party hospital staff between 2 P M to 10.30 P M in the notice. Further complainant has specifically stated in the complaint that at 2 A M in the morning complainant's husband was informed about the birth of a male baby and it was dead. On going through Exhibit B1 series, the copy of the case sheet produced by 2^nd opposite party, it is revealed that the critical situation of the baby was informed the complainant's husband and he has consented to carry out further treatment.

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As per Exhibit B1 case records and as per the admission of the complainant herself 2^nd

opposite party has examined the patient thrice before noon. It is also seen that she was once more examined by the doctor in the evening. Thus as per records the concerned doctor has repeatedly examined the patient.

It is alleged by the complainant that the death of the child occurred due to the delay in conducting caesarean by the 1^st and 2^nd opposite parties. Opposite parties has on the other hand contended that the death occurred due to a phenomenon known as Amniotic fluid embolism. Contention of the opposite parties are clearly substantiated by way of Exhibit B1 case sheet and Exhibit A4 discharge card.

To prove negligence on the part of a doctor, complainant has to definitely pass the 'Bolam test' as reiterated by Honourable Supreme Court in a catena of decisions. Moreover complainant has not taken any steps to adduce any expert evidence to throw light on the aspect of medical negligence. More over nothing has been brought to show that the doctor has not done what she ought to do or did something which a doctor possessing ordinary skills ought not to have done. Even though the treated doctor was cross examined, nothing was deposed to the effect that there was negligence on the part of 2^nd opposite party.

On the whole, no evidence has been lead by the complainant to prove the allegation of medical negligence on the part of opposite parties.

In the aforementioned circumstances we are unable to arrive at a conclusion that there is negligence on the part of opposite parties.

In the result complaint dismissed.

Pronounced in the open court on the 31^st day of December, 2009

PRESIDENT (SD)

MEMBER (SD)

MEMBER (SD)

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APPENDIX

Witness examined on the side of Complainant

PW1 - Complainant, Smt. T.G Savithri was examined

PW2 - Complainant's husband T.K. Gangadharan was examined

Witness examined on the side of Opposite party

DW1 – OP2 Dr. Lathika

Exhibits marked on the side of the complainant

1. Ext. A1 series – Acknowledgement cards

2. Ext. A2 – Lawyer notice dated 10^th September 2007.

3. Ext. A3 - Reply from Dr. C.K. Lathika dated 19/05/2007

4. Ext. A4 – Post Natal Discharge card of The Palakkad Dist Co-op. Hospital & Research Centre

Ltd, Palakkad

5. Ext. A5 Series – Lab report dated 09/03/2007

Exhibits marked on the side of the Opposite Party

1. Ext. B1 series – Pre-Operative Anaesthesia Assessment of Savithri and other connected papers