State Consumer Disputes Redressal Commission
Dr. (Mrs) S. Sakthy, M.B.B.S. Dgo ... vs P. Muthukrishnan Lig-1, 2519, Gandhi ... on 31 January, 2012
BEFORE THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI BEFORE THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION, CHENNAI BEFORE : Honble Thiru Justice M.THANIKACHALAM PRESIDENT Thiru A.K. ANNAMALAI, M.A.,M.L., M.Phil MEMBER (JUDICIAL) Thiru. S. SAMBANDAM MEMBERF.A.NO.817/2008
(Against order in C.C.NO.314/2007 on the file of the DCDRF, Coimbatore) DATED THIS THE 31st DAY OF JANUARY 2012
1. Dr. (Mrs) S. Sakthy, M.B.B.S. DGO Consultant Obstetrician Gynecologist Sri Sakthy Hospital No.1, Nehru Nagar, Police Quarters Road Bharathi Nagar, Ganapathy Coimbatore 6
2. Sri Shakthy Hospital No.1, Nehru Nagar, Police Quarters Road Bharathi Nagar, Ganapathy Coimbatore- 6 Appellants/ opposite parties Vs. P. Muthukrishnan LIG-1, 2519, Gandhi Maanagar Peelamedu, Coimbatore Respondent/ Complainant The Respondent as Complainant filed a complaint before the District Forum against the opposite parties, praying for a direction to the opposite parties to issue the complainant with a proper full medical records pertaining to the treatment of his wife, and to pay RS.450000/- towards compensation for mental agony and cot of Rs.3000/-. The District Forum allowed the complaint. Against the said order, this appeal is preferred praying to set aside the order of the District Forum dt.11.09.2008 in CC.No.314/2007.
This petition coming before us for hearing finally on 24.01.2012. Upon hearing the arguments of the counsel on both sides, perusing the material papers on record, lower court records, as well as the order passed by the District Forum, this commission made the following order:
Counsel for the Appellants/ opposite parties:
M/s. Anand, Abdul & Vinodh Associates Counsel for the Respondent/ Complainant: M/s. B. Vijayakumar M. THANIKACHALAM J, PRESIDENT
1. The opposite parties are challenging the order of the District Forum, in CC.No.314/2007, on the file of Coimbatore, wherein a direction has been issued against them, to pay a sum of Rs.3 lakhs as compensation with cost, based upon medical negligence.
2. Brief facts:
The complainants wife by name Sivakala, hereinafter called patient, was admitted in the 2nd opposite party hospital, run by the 1st opposite party/Doctor, for second delivery on 5.3.2007, though the expected date of delivery was originally fixed as 9.3.2007. As expected patient did not experience any pain of delivery, and therefore the complainant requested to discharge his wife, not conceded by the 1st opposite party. On the other hand, two nurses working in the hospital, have injected the patient, stimulating artificial pain, and thereafter the patient experienced pain from 4.00 p.m on 7.3.2007, on which date she delivered a male child, at about 5.49 pm. The complainant was informed both mother and baby are safe.
3. At about 7.00 p.m on the same day, two doctors from Ramakrishna Hospital, visited the 2nd opposite party, and at about 7.45 p.m, the 1st opposite party, informed the complainant that blood is required, and therefore he ran to the blood bank, to arrange for the same. Previously, the 1st opposite party has not informed, to make arrangement for blood, and that should be construed as negligence as well as deficiency in service. Even without providing ambulance, calling a call taxi the 1st opposite party sent the patient, to Ramakrishna Hospital for higher treatment, where she was declared dead on the way, even one our before. By the death of the patient, the complainant put to irreparable loss, mental agony, since he is shouldered with the responsibility of taking care of two children. Because of the negligence, defective service performed by the 1st opposite party, even without reserving the blood, and not properly treating the patient, the complainant lost his wife, for which he is entitled to compensation of Rs.4,50,000/-, which was demanded through legal notice, elicited only a false reply, thereby compelling the complainant to file this consumer complaint.
4. The opposite parties admitting the treatment given to the complainants wife, including the delivery, opposed the claim, contending that after admission, the 1st opposite party had taken personal care, in attending the patient, since the patient had pre-natal checkup also, as well as had seen the first delivery, that the expected date of delivery cannot be fixed specifically, and on the basis of the approximate date given, when the patient was admitted in the hospital, feeling pregnancy pain, she had checked the condition of the body, applied gel on 7.3.2007 at 8.00 a.m, and the patient was progressing for delivery. When the head of the infant was fixed, and the drain was progressively discharging, and the patient was about to deliver the baby, the complainant and his relatives opted for discharge, which was declined correctly. Required medicine viz. 2.5 units of Syntocin was administered to activate labour, and thereafter under the direct medical supervision of the 1st opposite party, she was taken the labour room, where she delivered a healthy normal male baby at 5.59 p.m., Thereafter alone some complications had taken place.
5. At the 3rd stage of labour, the placenta was not discharged for the patient, and immediately the 1st opposite party consulted a Senior Obstetrician, as well as anesthetist, who arrived at 6.30 p.m, advising the complainant also to bring four units of AB negative blood, ascertaining the availability of the same at PSG Hospital Blood Bank. At 6.50 p.m, the placenta was discharged manually, and the patient was under mask ventilation. At the time of discharge of Placenta manually it was noticed that uterus of the patient was inverted, commencing pleading also. In order to stop the pleading, as substitute, Hemoceal was given, and till 8.00 p.m blood had not reached, and therefore the opposite party have decided to shift the patient, to have better facility, to Sir Ramakrishna Hospital, which cannot be faulted, in a taxi, accompanied by two nurses, followed in a car by the 1st opposite party. But on the way, unfortunately the patient died, for which the doctor cannot be blamed, since they have followed all necessary precautions, required from a prudent doctor. For the death of the patient, the opposite parties went to the extent of damaging the property, giving police complaint, as well as publishing this incident, in news papers, tarnishing the reputation of the opposite parties. When notice was issued, proper reply was given.
Further averments are denied as false, praying to dismiss the complaint.
6. The parties went on trial before the District Forum by filing 10 documents, on the side of the complainant, and 12 documents on the side of the opposite party, out of which 6 documents are paper news cutting.
7. The District Forum, while analyzing the above documents, supported by the proof affidavits in the absence of any expert evidence, to find fault in treatment given by the opposite party, had noticed according to its wisdom, the opposite parties have committed three deficiency in service:
1. Attending the delivery without securing the blood that should be construed as negligence.
2. They had sent the patient in a call taxi, not travelling in the same car, committing negligence, in traveling another car, that also should be construed as negligence.
3. and that they have failed to handover the documents, to Ramakrishna Hospital, when the patient was transferred.
8. On the above findings, though the complainant had claimed Rs.4.5 lakhs, the District Forum ordered Rs.3 lakhs, apportioning the amount also, as per order dt.11.8.2008, which is impugned in this appeal.
9. Before us, by filing a petition, to receive the additional document, Ex.B13 was received.
10. The complainants wife/ patient, was taking treatment with the opposite party, after second conceivement, and the doctor also fixed the expected date of delivery as 9.3.2007. On 5.3.2007, the complainant took his wife to the 1st opposite party hospital, on examination the 1st opposite party felt that the patient will deliver the child, within the prescribed period, advising to admit and accordingly she was admitted in the hospital, not in dispute. But till 7.3.2007, there was no expected labour pain, and therefore it seems, on that date, the complainant requested the doctor to discharge his wife, which was declined, considering the position of the patient. As expected or induced by giving injection to activate the labour pain, the patient admittedly deliver a male baby, at about 5.49 p.m on the same day.
Though many allegations are leveled, as if nurse have injected the medicine to activate the labour pain, that was not found fault, as medical negligence, and therefore we refrain to go into detail. Upto the time of delivery, there was no problem, and it was a normal delivery, through vagina, though there was episiotomy. It appears, as pleaded even in the written version, the patient had not discharged the placenta fully. When this came to the knowledge of the 1st complainant, by discharge or bleeding, she consulted Dr.Neelayadakshi, a senior Obstetrician, as well as sought the help of anesthetist Dr.Santhanam. With their help/ aid, the 1st opposite party discharged the placenta manually, putting the patient under mask ventilation at about 6.15 p.m. Before that as prudent doctor the 1st opposite party, realized there may be some complication, requiring blood. Therefore, admittedly the 1st opposite party advised the complainant, to go and fetch four units of AB negative blood, ascertaining its availability at PSG blood bank. This is also admitted by the complainant, except disputing the time of information.
Till 7.45 or 8.00 p.m., blood was not brought by the complainant, and as substitute for blood, as usual Haemacel was given, that also failed to improve the condition of the patient. The 1st opposite party, attempted to secure ambulance to shift the patient, to have better treatment, at Ramakrishna Hospital, which she failed as proved by Ex.B13, since the driver was unable to reach the 1st opposite party hospital, due to traffic jam. Therefore, in order to save the patient, considering the emergency, the 1st opposite party sent the patient in a call taxi, with necessary equipments, accompanied by two nurses also, following it, in another car, alongwith her husband. The patient, before reaching Ramakrishna Hospital, unfortunately died.
The reason for death is recorded as due to acute inversion of uterus C hemorrhage shock(Ex.A2). After the death, there was many problems between the complainant and the opposite party, which we are not concerned very much.
Thereafter, issuing notice, unable to get any money, the consumer complaint was filed, as said above.
11. The case sheet maintained for the patient is marked as Ex.B12. One fault or deficiency recorded by the District Forum is non-supply of case record, while sending for higher treatment, in this case viz. Ramakrishna Hospital. Admittedly, no case sheet was taken by the 1st opposite party to Ramakrishna Hospital, and no referral letter was also given. Therefore, on the above said primafacie fact, the District Forum has recorded a finding, because of the fact, the case records were not sent to Ramakrishna Hospital, that should be construed as deficiency (3rd finding). In this case, the non-submission or sending of the case record, accompaning with the patient, may not loom large, in view of the fact, the doctor who treated the patient also followed the taxi, in which the patient was taken, accompanied by two nurses, not under very much in dispute. Since the doctor was accompanying the patient, she had every opportunity, to explain the proposed treating doctor, about the treatment given, and therefore the case record not taken, cannot be faulted, as did by the District Forum, in paragraph 12 of the judgement.
12. The learned counsel for the complainant would contend that sending the patient in a taxi, should be construed, per se negligence, which submission is not convincing. As proved by Ex.B13, though it is filed before us, the reason for the non-reaching of the ambulance was explained. A doctor, who is very much interested in taking the patient to the other hospital, for better treatment, cannot be expected, to search for another ambulance, and it is her judgement to take the patient in a taxi, considering the short distance, accompanied by two nurses, following the same, in a car. Patient alongwith two nurses, and doctor cannot travel conveniently or comfortable in a taxi, and therefore non-travelling of the doctor in the same taxi, cannot be faulted, as incorrectly did by the District Forum, in paragraph 11 of the judgement. Even assuming the doctor, accompanied the patient, in the same taxi, nothing could have been done, since admittedly she was unable to control the bleeding while the patient was in the 2nd opposite party hospital.
Therefore, the fact that the 1st opposite party followed in a separate car, sending the patient alongwith nurse, in another call taxi, will not come either within the meaning of negligence, or deficiency in service, and therefore the finding in paragraph 11 of the order is liable to be upset.
13. The first fault, or the finding of the District Forum, that attending the delivery, without securing the blood or reserving the blood, as the case may be, is deficiency in service. Under the stringent rules available for blood bank, it is impossible for all the nursing homes, to have the blood bank, and no rule is brought to our notice, that the doctors who attend delivery, should not conduct a nursing home, in the absence of blood bank, or in the absence of securing blood or reserving blood. In this case, the 1st opposite party alone had given treatment to the patient from the day one of the conceivement. Not only that, she had attended the first delivery for the patient also. Therefore, she knew the physical condition of the patient, and in her judgement, she expected normal delivery, which had happened in this case, though it is by inducement or activating labour pain, at later stage, that cannot be faulted per se.
Therefore, she felt that blood may not be necessary, since normal delivery was expected and in this view, not advising the complainant, to secure blood or before attending delivery, not procuring the blood, from the blood bank, cannot be faulted, as deficiency in service, or negligence in service. Till the time of delivery, there was no problem. After delivery, it was expected that the patient should discharge the placenta in entirety, which had not happened, and it may sometime, if the placenta was adhesive to the walls, and there is possibility for attachment and ejectment, even at later point of time also, even as per the literature, produced for our perusal. After sometime from the time of delivery, the first opposite party noticed the placenta was not discharged. As a prudent doctor, to attend this problem, anticipating PPH she called senior obstetrician Dr.Neelayadakshi, and in order to remove the placenta manually,and for the purpose of giving anesthesia, she also called D.Santhanam, Anesthetist, not very much questioned. Manually, the senior obstetrician discharged the placenta, which had not happened by any act of the 1st opposite party, and probably on its own inherently. Therefore, bleeding commenced and anticipating this, even as admitted by the complainant, he was requested to bring the blood, and that should be before 6.00 pm., and not as contended by the complainant at 8.00 pm, since by that time, the patient was shifted to Ramakrishna Hospital, as per the case record.
The complainant, who had been to PSG Hospital, or elsewhere to secure the blood, not reached , and the conditions of the patient became critical, and the effort of the 1st opposite party to secure ambulance also ended in vain. As pleaded in paragraph 11 of the written version, which is not only supported by proof affidavit, but also the case records, which is not challenged before us, the staffs called a call taxi, and the patient was shifted with saving apparatus, accompanied by nurses, followed by the 1st opposite party, in a car. The above said acts of the opposite parties, cannot be faulted at all. The above facts narrated are all recorded in Ex.B12, case sheet, and the same was supplied to the complainant also, subsequently. In the case sheet, we find an entry, regarding reposition of the uterus, as well as manual removal of placenta, ordering to bring blood at 6.30 pm, and we find note just before 7.35 p.m blood has not reached, hamoseal on flow, thereby showing alternative arrangements were taken by the opposite party, then and there continuously, from the commencement of the problem. At about 8.00 p.m, they have decided to shift the patient, since blood not secured, or not available, informing Ramakrishna Hospital also, about the seriousness of the patient, probably asking them to make necessary arrangement.
Unfortunately, as said above, the patient died on the way, so declared in the Ramakrishna Hospital also. Thus, going through the case record, which is supported by the written version, strengthened by proof affidavit, as well as medical literature, which says uterine attorney, is the most common case of significant bleeding in pregnant women, after delivery, we are unable to say that the 1st opposite party failed in her duty, at any point of time.
Therefore, the finding of the District Forum, the 1st opposite party attended delivery, without procuring blood cannot be taken as correct finding, considering the factual position, as well as the conditions of the mother, prior to the delivery, since there was no symptom of any complication at all.
14. It is also not the case of the complainant, nowhere in the complaint or affidavit, that the patient had problem, at the time of admission, or the doctor had explained any anticipated problem, and despite that, she failed to advise to secure blood or make preparation for blood, from the relatives or something like that. This being the position, we are unable to endorse the findings on three grounds, by the District Forum, to bring the opposite party within the ambit of medical negligence or deficiency in service, for the unexpected and unfortunate things happened, which is the known complication also. If the doctors are going to be faulted like this so casually, we feel no doctor would come to attend the patient, causing further complication, that is why the law contemplates that the doctor who attend the patient with utmost care, as a prudent doctor, to the expectation of the patient also, following the treatment established, should be relieved. In this case, the doctor has established that the treatment given by her to the patient, was correct whereas that treatment was not proved, to be negligence, by examining any expert or letting in any medical evidence, including taking us to literature, which act, the 1st opposite party failed to perform, bringing her act, within the meaning of deficiency or negligence. For the above said reasons, we conclude the District Forum, not approaching the merits of the case, legally and factually, probably taking sympathetic view, slapped deficiency upon the opposite party, which we are unable to confirm, and in this view, the appeal is meritorious.
15. In the result the appeal is allowed, setting aside the order of the District Forum in CC.No.314/2007 dt.11.9.2008, and the complaint is dismissed. There will be no order as to cost throughout.
Registry is directed to handover the Fixed Deposit Receipt, made by way of mandatory deposit, to the appellant duly discharged.
S. SAMBANDAM A.K. ANNAMALAI M. THANIKACHALAM MEMBER II JUDICIAL MEMBER PRESIDENT INDEX : YES / NO Rsh/d/mtj/FB/ Medical