State Consumer Disputes Redressal Commission
1. M/S Parjijatha Multispeciality ... vs Smt B.Radhika W/O Ramu on 20 January, 2011
FA 1292 of 2008 BEFORE THE A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT HYDERABAD F.A.No.1292 OF 2008 AGAINST C.C.No.67 OF 2007 DISTRICT FORUM NALGONDA Between: 1. M/s parjijatha Multispeciality Hospital Doctors Colony, Miryalaguda Post, Nalgonda District rep. by Dr.P.Parjijatha 2. Dr.P.Parijatha W/o Dr.Gnaneshwar R/o Doctors Colony, Miryalaguda Post Nalgonda District Appellants/opposite parties A N D Smt B.Radhika W/o Ramu Aged about 26 years, Occ: Housewife R/o Alur Village, Gattu Mandalam Mahaboobnagar District Respondent/complainant Counsel for the Appellant Sri V.Gourisankara Rao Counsel for the Respondent Sri C.Kesava Rao QUORUM: SRI SYED ABDULLAH, HONBLE MEMBER.
AND SRI R.LAKSHMINARASIMHA RAO, HONBLE MEMBER .
THURSDAY, THE TWENTIETH DAY OF JANUARY, TWO THOUSAND ELEVEN Oral Order (As per Sri R.Lakshminarasimha Rao, Honble Member) ***
1. The opposite parties are the appellants.
2. The facts of the case as seen from the complaint are that the complainant got admitted in the opposite party no.1 hospital on 6.1.2006 for delivery and on the same day opposite party no.2 conducted lower segment cesarean surgery.
A male baby was born. After being shifted to a room, the complainant developed complications such as giddiness, acute thrust and vomiting sensation. The opposite party no.2 had ignored the condition of the complainant. The complainant began experiencing oozing of blood from the wound site. The opposite party no.2 instructed a nurse at 7 p.m. to examine the patient. The nurse administered an injection to the complainant and at 8 p.m. the opposite party no.2 examined the complainant by which time the complainant lost enormous blood.
No emergency treatment was rendered to the complainant for management of postpartum hemorrhage. A bed sheet was drenched with blood and 15 pads had been changed. The complainant suffered hypovolemic shock in view of decreased blood volume in her body indicating internal bleeding caused by improper hemostasis before the wound was closed. The opposite party no.2 was negligent in not considering the internal bleeding before closing the wound and at 11.30 p.m. allowed the shifting of complainant to Yashoda Hospital, Hyderabad.
3. At 2 a.m. on 7.1.2006 the complainant was taken immediate surgical intervention of exploratory laparotomy in Yashoda Hospital and it revealed pelvic hematoma of 1 liter of blood plus clots on both sides of the pelvis of the complainant. The husband of the opposite party no.2, Dr.Gnaneswar, admitted that there was mistake and lapse on the part of the oppose party no.2 while conducting cesarean section and during the postoperative stage that led to blood loss and pelvic hematoma. Dr.Gnaneswar assured the husband of the complainant that the opposite parties would bear the medical expenses to be incurred for treatment of the complainant in Yashoda Hospital. The complainant had undergone stress, pain and mental agony and she had developed post surgical complications of acute respiratory syndrome which was a life threatening condition. She was kept on ventilator. She was discharged on 21.1.2006 and incurred more than a sum of `2,50,000/- for the cost of hospitalization, medicine, blood, doctors fees, lab tests and attendants expenses.
4. The opposite party no.2 in collusion with the local police foisted a false case against the husband of the complainant as a counter blast to the complaint filed by the complainant. Till 11.30 p.m. the opposite party no.2 had not given any effective and appropriate treatment. Another pregnant by name Telkapalli Indira of Palem village, Anumola Mandal was negligently treated by the opposite party no.2 in the first week of January 2006 for a similar problem of uncontrolled excessive bleeding after a careless surgery conducted by the opposite party no.2 and the incident was reported in Eenadu Daily on 5.1.2006. The complainant had requested the opposite party no.1 for furnishing of case sheet and other reports pertaining to the treatment and remitted a sum of `100/-
to the opposite party no.1 through DD No.337262 dated 16.2.2006. The opposite party no.2 encashed the demand draft and neither did furnish the copies of documents sought for nor had given any reply.
5. The opposite parties no.1 and 2 had filed common counter contending that the complainant had not attended full pregnancy check up with the opposite party no.1.
It was submitted that she came to the opposite party no.1 hospital for delivery pains and surgery of lower segment cesarean was conducted at 4.40 p.m. on 6.1.2006. After surgery, the wound site was not bleeding nor the complainant was bleeding from vagina and the opposite partyno.2 immediately attended to the complaints of the patient and every effort was made to render proper and effective treatment to control bleeding from vagina of the patient.
There was no internal bleeding into the abdomen nor was there any deterioration of the patients condition as also that there was no hypovolamic shock. The bleeding from the wound site was collected into the abdomen. The bleeding was from the uterus which did not contract properly.
6. At the request of the attendants of the complainant, she was shifted to Hyderabad at 9.30 p.m. on 6.1.2007 on promise of the complainants husband that they would pay ambulance charges and hospital charges, such as, surgeons fees, operation theatre charges, medicine charges to an extent of `50,000/-. The opposite partyno.2 had paid the ambulance charges and every possible step was taken to control the bleeding and the patient was stable without any further complication till reached Hyderabad. Because of non-availability of blood and possible further bleeding and other complications of postpartum hemorrhage like coagulatory failure was explained to the attendants of the complainant. The discharge summary of Yashoda Hospital would also show that there was no hypovolamic shock as BP was 100/70 when the complainant reached Hyderabad and there was no bleeding as also uterus was retracted well.
Postpartum hemorrhage is a known complication of any type of delivery whether normal or surgical. During her stay at Yashoda Hospital the complainant developed pelvic hematoma and left plural effusion and increase in quantity of free fluid in her abdomen.
7. It is possible that the pelvic hematoma was developed as a complication of postpartum hemorrhage. There was no disseminated intravascular coagulation at the time the patient reached Yashoda Hospital. Atonic postpartum hemorrhage resulted in bleeding of the complainant. The opposite party no.2 or her husband had not promised any amount for the medical expenses of the complainant at Yashoda Hospital. The complainants husband along with unsocial elements attacked the opposite partyno.1 hospital and threatened to kill the opposite party no.2 and damaged furniture of opposite party no.1 hospital. FIR in Cr.No.35 of 2006 was registered by the police in Miryalaguda town against them u/s 143, 448, 341 and 506 R/w Sec.34 IPC. The opposite parties had not received demand draft nor any request for furnishing of case sheet. There was no negligence in treatment on the part of opposite parties no.1 and 2.
8. The complainant has filed her affidavit. Exs.A1 to A17 were marked. The opposite party no.2 has filed his affidavit and got marked Ex.B1.
9. The District Forum has allowed the complaint on the premise that the husband of the opposite party no.2 accompanying the complainant to Yashoda, failure of the opposite partyno.2 in rendering proper treatment during the time of surgery and postoperative period as also her failure to furnish the case sheet record constitutes deficiency in service on the part of opposite parties no.1 and 2.
10. Aggrieved by the order of the District Forum, the opposite parties have preferred the appeal contending that the complainant failed to maintain two years gap between the first delivery and second pregnancy and she became pregnant within three months of the first delivery. It was contended that the opposite partyno.2 administered latest drug prostaglandian haemacel to increase the volume of blood. The cause of PPH was due to autonic uterus and the bleeding was not due to improper surgery. The complainant has not examined doctors of Yashoda Hospital.
11. The counsel for the complainant has filed his written arguments.
The point for consideration is whether the District Forum was right in recording finding that the opposite parties no.1 and 2 were negligent in rendering treatment to the complainant?
12. The complainant for her second delivery was admitted on 6.1.2006 to the opposite partyno.1 hospital where she had undergone cesarean section at 4.40 p.m. The opposite party no.1 has issued delivery certificate dated 14.1.2006 to the effect that the complainant delivered a male baby at 4.50 p.m. on 6.1.2006 at opposite party no.1 hospital. The opposite parties no.1 and 2 had contended that the complainant had not attended full time pregnancy check up with the opposite party no.1 and she came only for delivery. The plea of the opposite parties is not correct and made with an intention to avoid any responsibility as the prescription dated 25.6.2005 show that the opposite partyno.2 had examined the complainant on 25.6.2005 and 26.11.2005 and prescribed medicine. On 25.6.2005 Appolos Scan center had conducted ultrasound scan of abdomen of the complainant on reference by the opposite party no.2 and issued scan report with the observation that there was single viable fetus the complainant was carrying with 11+-1 weeks Gestational age. Prior to the performing of ultrasound scan on 25.12.2005, the opposite party no.2 advised the complainant for ultrasound scan on 23.12.2005 at Ajay Scanning and Diagnostic Center. A global view of the scan reports issued on examination of the complainant by the scan centers would reveal that the opposite party no.2 referred the complainant for the purpose of ultrasound scan of the fetus and age of the fetus etc. Thus, the contention that the complainant approached the opposite party at the time of delivery and not at any time prior to that occasion holds no water and liable to be rejected.
13. The contention of the complainant is that till 8 a.m. the opposite party no.2 had not attended to her despite request repeatedly made by her husband complaining of the complainant experiencing complications such as giddiness, acute thrust and vomiting sensation. The opposite party no.2 had denied the allegation stating that she had immediately attended to the complaints without any delay and she had taken all possible steps to control oozing of blood from vagina of the complainant. A perusal of case sheet shows that surgery was conducted at 4.40 p.m and the condition of the patient at 6 p.m was, PR 90, BP 110/70, HP/2 NAD and at 6.30 p.m. PR was recorded as 100/100 p.m. BP 110/70 HP/2 NAD. In this fashion this parameters were noted every half an hour till 9.30 p.m. Medicine, 5% dextrose, DNS etc., was administered at 6.00 p.m. which was substituted by Metrofin at 6.30 p.m. and it is at 7 p.m. it was advised that blood transfusion has to be done besides administration of prostaglandin and heamocel. Two units of blood transfusion was done at 8 p.m. There is no evidence brought on record as to what was the condition of the complainant after the surgery was performed till 60 clock even if we go by the case sheet relied upon by the opposite parties.
14. The opposite party no.1 hospital is not equipped with the sophisticated equipment to combat a situation where the patient was experiencing PPH.
This fact is proved by two related facts, the opposite party no.2 proceeded to perform the operation without taking steps as to the availability of blood as the operation in question was elective and secondly, another patient by name Indira died of bleeding after she had under gone caesarian section in the opposite party no.1 hospital.
The opposite parties admitted that there was no availability of blood.
15. The complainant suffered from bleeding, blood loss which require effective and emergency treatment at the opposite party no.1 hospital. The bleeding was so threatening that 15 pads were changed and according to the complainant a bed sheet was drenched. The opposite party had not denied the blood loss and the bleeding on a large scale. Transfusion of two units of blood to the complainant is a circumstance to view the quantity of loss of blood. The opposite party no.2 has not stated when she had asked the attendants of the complainant to get the blood when the patient was suffering from PPH.
16. The requirement of the blood to the patient during postoperative stage was within the knowledge of the opposite party no.2 and despite the fact that the opposite party no.2 had gone on stating because of non-availability of the blood with the opposite parties and in view of possible further bleeding at any time and other complications postpartum hemorrhage (PPH) like coagulatory failure was explained to the attendants of the complainant and hence her attendants requested the opposite party no.2 for shift to higher centers . The opposite party no.2 was supposed to take due care by asking the complainants attendants to take steps for arrangement of blood and its availability during the period of operation and postoperative stage particularly in the light of their contention that there was every possibility of further bleeding and development of other complications of PPH like coagulatory failure. The opposite party no.2 is expected to bring to her task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care.
17. In Bolam v. Friern Hospital Management Committee, WLR at p.586 it is held as follows:
Where you get a situation which involves the use of some special skill or competence, then the test as to whether there has been negligence or not is not the test of the man on the top of a Clapham omnibus, because he has not got this special skill. The test is the standard of the ordinary skilled man exercising and professing to have that special skill. A man need not possess the highest expert skill.It is well established law that it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular art
18. Lord Wilberforce in Kooragang Investment Pty.Ltd vs Richardson and Wrench Ltd 1982 AC 462, stated :
Negligence is a method of performing an act instead of it being done carefully, it is done negligently. Negligence in common parlance mean and imply failure to exercise the care expected of a reasonable prudent person. It is the breach of duty and negligence in law ranging from inadvertence to shameful disregard of safety of others. In most cases it is caused by heedlessness or inadvertence by which the negligent party unaware of the results which may follow from his act. Negligence is thus a breach of duty or lack of proper care in doing something , in short, it is want of attention and doing something which a prudent and reasonable man would not do(Blacks Law Dictionary).
18. The opposite party no.2 states that the bleeding was from the wound site and not on account of any improper performing of surgery.
This version of the opposite party no.2 if read in contrast to her mentioning in the counter that the bleeding was on account of improper contracting of uterus of the complainant, it becomes clear that the opposite party no.2 had not exercised due care in attending to the complications developed during the post operative stage. It was mentioned in the counter by the opposite party no.2 as there was no internal bleeding into the abdomen. It is only external bleeding from the uterus. The bleeding from the wound site will be collected into the abdomen. The bleeding was from the uterus which was not contracting properly. In para 8 of the counter it is pleaded, it is only after subsequent period during her stay at Yashoda Hospital, she developed pelvic hemotoma and left plural effusion and the free fluid in the abdomen is increased. The discharge summary of Yashoda Hospital has been made basis of the case of the opposite parties instead of the case sheet pertaining to the opposite party no.1 hospital to state the condition of the complainant at the opposite party no.1 hospital.
19. It is held by the Apex Court in (2004) 8 Supreme Court Cases 56 in Savita Garg (Smt) V. Director, National Heart Institute that when a prima facie case is established, it is the duty of the opposite parties to prove their case, since it is only the opposite parties who are aware of the exact line of treatment that has been given to the patient. It was also held by the Apex Court that once a claim petition is filed and the complainant has successfully discharged the initial burden that the hospital/clinic/doctor was negligent and that as a result of such negligence, the patient died, then in that case, the burden lies on the hospital and the doctor concerned, who treated the patient, to show that there was no negligence involved in the treatment.
20. The complainant developed PPH coagulatory failure immediately after delivery by cesarean section and there was a complaint of hypovolamic shock disseminated intravascular coagulation which require utmost medical care and attention from the opposite parties. The opposite parties no.1 and 2 had not furnished copy of case sheet nor issued discharge certificate showing the attention they had paid to the complainant during the post operative stage. The case sheet was requested to be issued by submitting demand draft for Rs.100/-. The application for request of issue of case sheet from the side of the complainant was acknowledged by the opposite parties no.1 and 2 as evidenced by the acknowledgement cards and endorsement of the postal authorities.
The opposite parties had not come forward with any explanation for the news item in regard to the death of a lady by name Telkapalli Indira who as the news item shows, on account of negligence of the opposite party no.2, died due to uncontrolled bleeding immediately after delivery at the opposite party no.1 hospital.
21. The discharge summary of Yashoda Hospital indicates that the opposite party no.1 referred the complainant for PPH and that she was referred with excessive bleeding PV. The opposite party no.2 in her affidavit has stated that the complainant had not suffered hypovolamic shock, dissemination intravascular coagulation and active oozing at the wound site at the opposite party no.1 hospital an till she was received at Yashoda Hospital. A patient goes to the hospital on account of its reputation so as to get best.
22. On opening abdomen of the complainant, it was found by the doctors at Yashoda Hospital that there was one liter of blood clot on both sides of pelvis and her uterus contracted well. The blood loss at the opposite party no.1 hospital has to be accounted by the opposite parties no.1 and 2 as to the steps they had taken during postoperative stage which has not been spelt out except the case sheet which the complainant describes as tampered on the premise that it was issued to her nor was it filed before the District Forum at the time of enquiry of the complaint except that it was filed when the case was posted for arguments.
23. The handbook Obstetric Emergencies by Kamini A Rao gives description of postpartum hemorrhage as postpartum hemorrhage (PPH) is defined as bleeding from the genital tract in excess of 500ml after delivery . As a working role postpartum hemorrhage is considered when bleeding after delivery leads to any of the following:
Shock Fall in hemotcrit value grater than 20% from normal Blood replacement.
24. The cause for PPH is shown as atonic uterus, tears cervix, vagina or perineum partially separated and retained placenta, retained placental fragments, uterine inversion and uterine rupture. The management prescribed for control link of the PPH is, general as per hemorrhajic shock, specific for the cases depending on the cause and under the third category it was suggested that if bleedings persists in spite of the treatment rendered under the first two categories, clotting status by a bedside test has to be checked and failure of clotting that occurs after 7 minutes or formation of a soft clot that breaks easily a clotting disorder. In case of atonic uterus, at page 165 of the book it was suggested that massage the uterine fundus expel blood and clots as they may inhibit effective uterine contractions. Massage should not be so vigorous so as to cause severe pain to the woman or a broad ligament hematoma. 2. Oxytocic drugs are to be given together or sequentially and if bleeding continues placenta and membranes have to be checked again and in case portions are found missing, uterine cavity has to be explored for the remaining fragments and they are to be removed. In this manner many other suggestions have been made by the author for controlling the postpartum hemorrhage.
25. The opposite parties failed to administer massage the uterus of the complainant though there was abnormal bleeding and the opposite party no.2 diagnosed her to have suffered from PPH. The opposite parties denied the treatment rendered to the complainant prior to the date of her admission to the opposite party no.1 hospital as against the prescriptions containing the medical advice and treatment prescribed in the prescriptions issued by the opposite party no.2.The opposite parties had not exercised due care in rendering treatment to the complainant during the posit operative stage. The opposite party no.2 admitted that her husband who is also a doctor admitted her negligence and offered to bear the medical expenses of the complainant during her treatment at Yashoda Hospital. It is not difficult for the opposite party no.2 to file her husbands affidavit or to examine before the District Forum.
26. The complainant was admitted to Yashoda Hospital at 2 a.m. the next day of her discharge from the opposite partyno.1 hospital.
The opposite parties stated that they had shifted the complainant at 9 p.m. by bearig the expenses for ambulance.
On ambulance it would not more than two hours to reach Hyderabad from Nalgonda. Therefore, the contention of the complainant that she was discharged at 11 p.m. finds force and is sustainable
27. All these facts in the light of aforementioned decisions would show the medical negligence on the part of the opposite parties right from the deputation of a nurse for the postoperative stage treatment at the opposite party no.1 hospital till the complainant was shifted to Yashoda Hospital besides the retaining of the case records till final stage of complaint without issuing copies thereof to the complainant, constitute deficiency in service on the part of the opposite parties.
28. The District Forum has awarded an amount of `4,09,183/- towards compensation. The complainant claimed an amount of `7,29,183/- with interest and she has stated that she had incurred a sum of `1,89,183/- towards medical expenditure at Yashoda Hospital. The final bill statement dated 21.1.2006 show that the complainant had incurred an amount of for `96,633/-. The complainant had suffered pain and mental tension on account of the deficiency of service rendered by the opposite parties. A sum of `50,000/- for pain and suffering is reasonable besides the amount spent by the complainant under Final Bill Statment issued by Yashoda Hospital, `96,633/- Therefore, a sum of `1,50,000/- if awarded on all counts to the complainant would meet the ends of justice. Accordingly, the amount awarded by the District Forum is modified.
25. In the result, the appeal is allowed. The order of the District Forum is modified by reducing the amount of `4,09,183/- to `1,50,000/- and the rest of the order upheld. In the circumstances of the case there shall be no order as to costs.
MEMBER MEMBER Dt.20.01.2011 KMK*