State Consumer Disputes Redressal Commission
Smt. Karuna vs Maharaja Agarsen Hospital And Others on 26 May, 2016
Daily Order IN THE STATE COMMISSION: DELHI (Constituted under Section 9 of the Consumer Protection Act, 1986) Date of Decision: 26.05.2016 Complaint Case No. 60/2009 In the matter of: Smt. Karuna W/o Sh. Charles R/o X-14, Paharganj Chitragupta Road New Delhi-110055 .........Complainant Versus Maharaja Agarsen Hospital Through Medical Supdt. Punjabi Bagh New Delhi-110026 Dr. Parul Sehgal IVF Specialist Maharaja Agarsen Hospital Punjab Bagh New Delhi .........Opposite Parties CORAM N P KAUSHIK - Member (Judicial) 1. Whether reporters of local newspaper be allowed to see the judgment? Yes 2. To be referred to the reporter or not? Yes N P KAUSHIK - MEMBER (JUDICIAL) JUDGEMENT
Complaint in brief of the complainant Ms. Karuna is that she is married to one Sh. Charles and living in Dubai. She is aged about 29 years. She failed to give birth to a child in a span of two years of marriage. She got herself medically examined in Dubai where she came to know that her fallopian tubes (uterus tubes) are bilaterally blocked. She was advised to go for a test tube baby. Finding the procedure costly in Dubai, she came to Delhi and got herself checked up in Sir Ganga Ram Hospital in Delhi. She was advised to go for IVF procedure. Again finding the procedure expensive, she went to Maharaja Agrasen Hospital Punjabi Bagh, New Delhi (in short the OP-1) where she was seen by Dr. Parul Sehgal, an IVF specialist (in short the OP-2).
Grievance of the complainant is that OP-2 gave her heavy injections and medicines which resulted into deterioration of her condition. She found that IUI (Intra Uterine Insemination) has been done upon her instead of IVF (In vitro Fertilisation). Contention of the complainant is that in her case only IVF procedure was advisable but the OP performed IUI deliberately. Her condition became critical. She got consultation from some other doctor who told her that the treatment given to her was improper. This would result into bursting of her uterus.
Next submission of the complainant is that the OP had assured her that after the procedure of IVF her fallopian tubes would get opened and she would be able to conceive. She allegedly spent Rs. 1 lac on this procedure and the whole exercise remained unfruitful. Complainant further stated that she spent Rs. 3 lacs till date and would have to spend another Rs. 2 lacs for success on another IVF procedure. She has thus claimed compensation to the tune of Rs. 20 lacs besides claiming the alleged amount of Rs. 3 lacs spent in the OP hospital. Litigation charges of Rs. 11,000/- have also been claimed.
A joint written version was filed by OP-1 & 2.
Defence raised by the OPs is that usually one patient may carry two or three different reports relating to fallopian tubes at one time. A fallopian tube sometimes remains open for a certain time and the same get blocked on another occasion. OPs have referred to HSG report (Hysterosalpingography Report) relied upon by the complainant with the name of 'Nidhi'. It may be mentioned here that the complainant got herself registered with the OPs by the name of 'Karuna'.
Matter was referred to Medical Council of Delhi for expert opinion. Delhi Medical Council gave its opinion vide order dated 07.05.2010. An appeal preferred against the said orders by the OPs was allowed by the Medical Council of India vide its order dated 30.12.2010. Complainant Ms. Karuna Nidhi (as her name mentioned in the order) did not appear before the Ethics Committee despite notice and repeated requests. For this reason Ethics Committee allowed the appeal of the OPs and treated the matter as closed. Relevant portions of the report of Delhi Medical Council dated 12.04.2010 and the report of Medical Council of India dated 30.12.2010 are reproduced below:
"Delhi Medical Council:
Order dated 12.04.2010 The Delhi Medical Council examined a complaint of Smt. Karunanidhi R/o House No. 910, Jain Nagar, Kanjhawala Road, Bawana, Delhi, forwarded by Directorate of Health Services, alleging medical negligence on the part of Dr. Parul Sehgal, in the treatment administered to her at Maharaja Agarsen Hospital.
The Delhi Medical Council perused the complaint, written statements of Dr. Parul Sehgal, Dr. Anand Bansal, Medical Superintendent, Maharaja Agrasen Hospital, as provided by Directorate of Health Services, other document on record and heard the following in person:-
Smt. Ved Putri Mother of the complainant Ms. Deep Shikha Sister of the complainant Dr. Parul Sehgal IVF Specialist, Maharaja Agrasen Hospital Dr. Anand Bansal Medical Superintendent, Maharaja Agarsen Hospital
Ms. Deep Sehgal stated that the complainant is in Dubai and that she was conversant with the facts of this complaint. She further averred that all the medical records pertaining to the treatment received by the complainant prior to her consultation with Dr. Parul Sehgal, including the hysterosalpingography report dated 13th August, 2007 where it was specifically opined that complainant Nidhi's tubes were blocked, were shown to Dr. Parul Sehgal. The complainant went to Dr. Parul Sehgal for IVF treatment, and inspite of her tubes being blocked, Dr. Parul Sehgal treated her with IUI.
Dr. Parul Sehgal stated that the complainant during consultation with her told her verbally that there was no blockage in her tubes. The complainant had never shared with her the Hysterosalpingography report dated 13.08.2007. She further stated that she had made it clear and counselled both the husband and wife that due to poor egg formation she was cancelling the IVF oocyte pickup procedure, as she had little chances of success if follicle formation is less than 2. Dr. Parul Sehgal further added that she did IUI with good intention of making the complainant pregnant as she (Dr. Parul Sehgal) was under the impression that her tubes were fine. She only tried to save complainant's money and invasive procedure and opted for IUI with elaborate discussion with complainant under consent.
The Delhi Medical Council observes that the patient Mrs. Karunanidhi aged 29 years went to Dr. Parul Sehgal for treatment of infertility. As per the records available, the Bilateral fallopian tubes of the patient were blocked. In the event of Bilateral blocked tubes, IUI is not beneficial at all. Such patients require IVF. Patient has signed the consent for IUI procedure despite knowing about her Bilateral blocked tubes. As per the statement of Dr. Parul Sehgal, she was told by the patient that her tubes were fine. Doctor should not go by verbal statements of patient. Dr. Parul Sehgal should have insisted for the report or should have advised fresh tube testing before starting the treatment of infertility.
It is, therefore, the decision of the Delhi Medical Council that Dr. Parul Sehgal made an error in judgement albeit with the best of intentions. The Delhi Medical Council, therefore, issues as warning to Dr. Parul Sehgal (DMC registration No. 19000).
Complainant stands disposed."
Medical Council of India:
Order dated 30.12.2010 "The Ethics Committee considered the matter with regard to appeal made by Dr. Parul Sehgal against the order dated 12.04.2010 passed by Delhi Medical Council and noted that the Council Office had issued notices to the doctor as well as to the complainant but the complainant had not appeared before the Committee despite repeated requests. Therefore, the Ethics Committee decided to allow the appeal.
As per directions of the Ethics Committee, the Council has sent a letter dated 20.11.2010 to the complainant Mrs. Karunanidhi to appear before the Ethics Committee on scheduled date and time. The Ethics Committee further noted that as the Respondent had not appeared before the Ethics Committee even after repeated reminders, therefore, the Committee decided to allow her appeal and treat the matter as closed."
Now the controversy arises: a) whether the OPs were negligent in performing the procedure of IUF upon the complainant, b) whether the OPs were cognizant of the fact that the fallopian tubes of the complainant were blocked.
Before proceedings further, it may be mentioned here that before Delhi Medical Council it was not the complainant but her sister named Ms. Deep Shikha who appeared and represented the case of the complainant. Ms. Deep Shikha had stated that her sister (the complainant) had shown to OP-2 her hysterosalpingography report dated 13.08.2007. On the contrary, OPs have relied upon the medical examination papers of the complainant and her husband prepared by OP-2 on the day she reported to her first. While recording the history of the patient, OP-2 put sign of interrogation against the words, 'overian cyst aspiration' and another sign of interrogation against the words 'report'. Against the column HSG plan the words 'B/L Spill' are recorded. Against the column 'PLAN' the words 'IVF' find a mention. Follicular monitoring chart prepared by the OPs shows that only one follicle was seen. To make the things simple, one follicle after its maturity only gives rise to one ovam. OP-2 who argued her case in person stated that it was on the basis of the documents shown to her that she recorded the factum of both the fallopian tubes open. It was in this scenario that OP-2 instead of planning IVF, advised the patient to undergo the procedure of IUI. Report of Delhi Medical Council (though set aside in appeal) simply held the doctor guilty for going by the verbal statement of the patient. As discussed above, against the column HSG, the doctor (OP-2) has clearly recorded 'B/L Spill' showing the fallopian tubes open. There is no sign of interrogation against this column. OP-2 has been vigilant enough in putting the sign of interrogation at two other places expressing her doubts. The column HSG does not show any sign of interrogation. It goes to show that OP-2 was carried by some documents placed before her. Be that as it may, the consent form duly signed by the complainant reads that the consent was obtained for IUI procedure. Complainant is a literate lady who travelled from Dubai to Delhi for getting the said treatment. It is not the case of the complainant that she did not sign the said consent form with her eyes wide open. Having signed the consent form for IUI procedure, it does not now lie in the mouth of the complainant that she was misled by the OPs in any manner.
Complainant has alleged that the procedure of IUI was would burst her uterus. No medical literature has been placed before this Commission by the complainant in support of her contention. Only 0.3 ml to 0.5 ml of washed semen is injected into the uterus of the patient during the procedure of IUI. Proposition of bursting of the uterus is a figment of imagination of the complainant. Complainant has also expressed her apprehension that the procedure of IVF may fail because of the wrong procedure having been done on her. Again no medical literature has been placed on record to show that the complainant has now become unfit for IVF after having been put to IUI once. Both the apprehensions of the complainant are thus false.
At the best the complainant has tried to put up a case that the line of treatment was wrong. In any case, it is not a case of medical negligence. Applying Bolam's test, it is only a reasonable skill and reasonable knowledge that is expected from the OP-2 doctor.
There was no commercial angle in going for the procedure of IUI which cost the patient only Rs. 3500/- instead of Rs. 1 lacs required for IVF procedure. OPs had acted bonafide and in the benefit of the complainant who was desperate to conceive. They advised her to undergo IUI on a representation that her fallopian tubes were open. I am, therefore, of the considered opinion that the complainant has failed to prove her case that the OPs were negligent in any manner. Complaint is accordingly dismissed.
Copy of the orders be made available to the parties free of costs as per rules and thereafter the file consigned to Records.
(N P KAUSHIK) MEMBER (JUDICIAL)