State Consumer Disputes Redressal Commission
Dr.C.Suvarchala, vs T.P.Saseendran, on 30 September, 2011
Daily Order
Kerala State Consumer Disputes Redressal Commission Vazhuthacaud,Thiruvananthapuram First Appeal No. 573/2005 (Arisen out of Order Dated null in Case No. of District ) 1. C Suvarchala Obstetrician & Gynaecologist,J.J S Hospital,Kannur BEFORE: HONARABLE MR. JUSTICE SHRI.K.R.UDAYABHANU PRESIDENT PRESENT: ORDER
KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAD THIRUVANANTHAPURAM
APPEAL 573/05
JUDGMENT DATED: 30..9..2011
PRESENT
JUSTICE SRI.K.R.UDAYABHANU : PRESIDENT
Dr.C.Suvarchala, : APPELLANT
Obstetrician & Gynaecologist,
J.J.S. Hospital, Kannur -2.
(By Adv.M.C.Suresh)
Vs.
1. T.P.Saseendran, : RESPONDENTS
Thunoli Puthiyapurayil House,
Pallikunnu Amsom Desom,
Pallikunnu.P.O., Kannur
2. M.C.Usha, W/o of T.P.Saseendran,
-do-do-
(By Adv.M.M.Deepa)
JUDGMENT
JUSTICE SRI.K.R.UDAYABHANU : PRESIDENT The appellant is the opposite party in OP.467/99 in the file of CDRF, Kannur. The appellant is under orders to pay a sum of Rs.1,00,000/- as compensation and cost of Rs.1000/-.
2. The allegations against the opposite party/appellant/Gynecologist are as follows. The 2nd complainant, the wife of the 1st complainant was admitted in the hospital of the opposite party on 8.1.99 for delivery. On the same day at about 7.23pm she gave birth to a child. The complainants were told that it was a normal delivery. According to the 1st complainant/husband he left the hospital deputing one Vinod and others as bystanders in the hospital. At about 9pm he received a telephone call to the effect that condition of his wife is very critical and when reached the hospital he was told that there is excessive bleeding. He was told the opposite party and nurses that there is nothing serious and that medicines have been administered and that bleeding will stop. Subsequently the opposite party told the complainant to take his wife to some other hospital and her condition is very critical. By the time huge quantity of blood has been oozed out. She was taken to AKG hospital, Kannur. The duty doctor of AKG hospital was reluctant to admit the patient as her condition was so critical and she was badly in need of blood transfusion. He was told to arrange 10 bottles of B+ve blood. Senior doctors were called and an emergency Hysterectomy was done. It is after much efforts that can obtain 6 bottles of blood. The doctors of AKG hospital diagonosed the case of 2nd complainant as one of postpartum hemorrhage (PPH) and that due to excessive bleeding hemoglobin level had came down to 3.ogm and B.P to 30. He was told that the patient was brought to the AKG hospital in a belated stage. Failure to receive proper treatment was due to the negligence of the opposite party. Steps to stop bleeding which ought to have been taken immediately after delivery was not done. The complainant is not in a position to have another child.. The complainants have sought for a sum of Rs.2.5 lakhs altogether as compensation.
3. The opposite party has filed version stating that the 2nd complainant was brought to the hospital at about 1.45pm with labour pain on 8.1.99. It was her 2nd pregnancy. Expected date of delivery was 7.1.99. The hemoglobin level was 11gm percent. The BP was 120/80. Everything was normal. She delivered a male baby weighing 3.5 kg. after a medio lateral episiotomy at 7.23pm. Placenta and membrane were expelled completely and medicines were administered for contraction of the uterus to prevent bleeding. Inspite of the same she had mild degree of bleeding(PPH). The same was controlled by giving another injection Methergin IV and injection Prostodin. IV fluid were continued. Uterus was explored and few clots were removed. Cervix and vagina explored and were found to be intact. Uterus massage was done for contraction and retraction of uterus and within a few minutes bleeding was arrested. BP was 110/80 and pulse 88 per minute. She was given injection Syntocinon 10 units in 5% Dextrose. Instruction was given to repeat injection Prostodin 1 ampule after ½ hour. She was kept in the labour room for continued observation. The staff nurse was instructed to intimate the opposite party if there is further bleeding. At about 9pm the opposite party was informed by the staff nurse that the patient was bleeding again and that IV drip with injection Syntocinon was on flow. Immediately the opposite party rushed to the hospital. Her BP had droped 100/70 and pulse 88. Uterus was flabby and there was bleeding. Uterus was again explored and clots evacuated. Uterine massage continued and a 3rd dose of injection Prostadine alongwith injection Methergin IV were also given to arrest bleeding. The relatives were asked to get one bottle of B+ve blood for transfusion but there was no male bystander. Arrangements were made to inform the husband to arrange for donars. IV fluids for replacements were continued but BP droped to 80/50. She continued to bleed and BP droped to 90/60. Injection Escortin 100mg IV was administered to combat shock. At about 10pm the BP droped further to 80/50. The physician Dr.Mustafa was consulted at about 10.15pm. The BP further dropped to an alarming level of 70 systolic. Dopamine drip was immediately started to bring up the BP. At about 10.30pm the Physician arrived and examined her. As the Laboratory was not functioning during the night hours the Lab investigation could not be done. Hence it was suggest to transfer her to a major institution. She was shifted to AKG hospital situated just about 100 meters from the hospital of the 1st opposite party. Ambulance was arranged. At about 11pm the patient was shifted to AKG hospital with IV drip on flow. She was referred as a case of atonic PPH with hemorrhagic shock, not amenable to the conservative treatment. It is denied that there was any negligence on the part of the opposite party. It is asserted that the bleeding had stopped and the condition remained stable for about 1 ½ hours after delivery. At AKG hospital emergency hysteroctomy was done. The shifting was previously intimated to the duty doctor of AKG hospital. The required standard treatment was given to the patient. The 1st complainant/husband should not have left the hospital before the patient was shifted to ward. It was a sudden and unpredictable complication that developed. For PPH due to atonic uterus the only course left open is to conduct hysterectomy.
The evidence adduced consisted of the testimony of PW1,PW2 and DW1; ExtsA1 and A2, B1 and X1..
The Forum has found fault with the opposite party in not referring the patient to a higher centre earlier. The Forum has also found relying on the deposition of DW1 the opposite party doctor that there is no qualified nurses in the hospital of the opposite party. The Forum has also found that DW1 even could not say as to upto which classes the nurses have studied. It was found that opposite party left the hospital after directing the staff nurse to inform as to whether there is further bleeding by noticing it by the naked eye and that the same also amounted to negligence. The writings in the case sheet that no male bystander was available to procure B+ve blood was falsely incorporated later. It was found that there is no facility in the above hospital for conducting hysterectomy. It was noted that DW1 has mentioned that at 8pm bleeding was reduced and at 8.15 there was only slight bleeding. The version of DW1 that she left the hospital at 8.30pm was found to be not reliable. It was noted that she left the hospital after noticing excessive bleeding at 8.15 pm and that she should have anticipated possibility of atonic PPH. It is noted that DW1 has admitted that at 9pm she found blood transfusion is essential. It is noted there is no record to show that the hospital made any enquiries to procure blood. The reason for waiting till 11pm for referring patient stands not explained, it is noted. The case that bleeding was arrested at about 1 ½ hours after delivery was not believed. The evidence of PW2 the doctor who examined the patient at AKG hospital that the patient was in state of shock due to PPH and emergency hysterectomy was required to save the life of the patient was relied. The administration of the medicines as contended is not noted in Ext.B1 case sheet of the opposite party's hospital.
The counsel for the appellant/opposite party has relied on the observations in the Text Book Obstetrics by D.C.Dutta to point out that the steps to manage hemorrhage due to atonic uterus was taken at the opposite party hospital and that it was inevitable in certain cases to resort to hysterectomy. It is not disputed as to the findings of the Forum that there was no qualified nurses in the above hospital. It is admitted by the opposite party that laboratory of the hospital was not functioning in the night. It is also evident that there was not duty doctor present in the above hospital. It is mentioned in the version it is at about 9pm that the opposite party was informed by the nurses that the complainant was bleeding again and that the opposite party reached the hospital and examined the complainant and found that the uterus was flabby and there was bleeding. Evidently she would have diagnosed the case as one of atonic PPH. It is also stated that the blood could not be procured. Of course it is alleged that there was no male bystanders. Evidently from 9 0 clock there was bleeding and the opposite party wanted to do blood transfusion. The BP was dropping. As admitted the test could not be done as the Lab was not working in the night hours. When the patient was brought to the AKG hospital subsequently at 11.30pm BP is noted as 60. At 12.45pm the blood transfusion commenced and she was subjected to emergency hysterectomy. She was inpatient at AKG hospital for 10 days . As noted by the Forum Ext.B1 case sheet is just loose sheets stappled together. At 9.15pm the requirements of immediate blood transfusion is noted. In Ext.B1 it is repeatedly noted that there was no donors and no male bystanders. It is also noted at 10.30pm that it was decided to do hysterectomy but anesthetist was not available and the situation was explained to the bystander and that AKG hospital was contacted and requested to provide ambulance As per the version it is at 10.30pm that the Physician Dr.Mustafa examined the patient and medicines were given . The patient was shifted at 11pm is noted in Ext.B1. We find that there is no proper explanation as to delay to refer the patient at the earliest especially as the higher centre, hospital is situated just 100 meters away from the hospital of the opposite party as mentioned in the version. As noted in the version the opposite party found that the uterus is flabby at about 9 pm. In view of the fact that there was no proper facility in the opposite party's hospital for conducting hysterectomy and in view of the fact mentioned in Ext.B1 itself at 9.15pm that there was no donors the patient ought to have been referred to the higher centre immediately. Evidently the condition was very serious. The opposite party was reluctant to refer the 2nd complainant to a higher centre inspite of the fact that blood was not available and blood transfusion was essential and that there was no anesthetist available to conduct hysterectomy. We find that there is culpable lapse on the part of the opposite party in retaining the patient till 11pm till she was critical. The forum has directed to pay a compensation of Rs.1 lakh. No interest has been ordered to be paid. We find that the order of the Forum does not call for any interference. Hence the appeal is dismissed. Opposite party/appellant is directed to make the payment within 3 months from the date of receipt of this order failing which the complainant will be entitled for interest at 12% from 30.9.2011 the date of this order.
Office will forward the LCR to the Forum along with the copy of this order.
JUSTICE K.R.UDAYABHANU : PRESIDENT
ps
[HONARABLE MR. JUSTICE SHRI.K.R.UDAYABHANU] PRESIDENT