State Consumer Disputes Redressal Commission
Pardeep Kumar Dhillon vs Neena Rani on 3 August, 2015
2nd Additional Bench
PUNJAB STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
DAKSHIN MARG, SECTOR 37-A, CHANDIGARH
First Appeal No. 1531 of 2014
Date of institution: 25.11.2014
Date of decision : 03.08.2015
Dr. Pardeep Kaur Dhillon Medical Officer Swami Premanand Charitable
Hospital, GT Road, Mukerian District Hoshiarpur
.....Appellant/Opposite Party
Versus
Mrs. Neena Rani wife of Sh. Sukhwant Singh aged 29 years resident of
village Mehtabpur Tehsil Mukerian Dasuya, District Hoshiarpur, Punjab.
.....Respondent/complainant
First Appeal against the order dated 20.10.2014
passed by the District Consumer Disputes
Redressal Forum, Hoshiarpur
Before:-
Sh. Gurcharan Singh Saran, Presiding Judicial Member
Sh. Jasbir Singh Gill, Member Mrs. Surinder Pal Kaur, Member Present:-
For the appellant : Sh. Sumit Saddi, Advocate
For the respondent : Sh. C.S. Marwaha, Advocate
GURCHARAN SINGH SARAN (PRESIDING JUDICIAL MEMBER)
This appeal has been preferred by appellant/Opposite Party (hereinafter referred as 'OP') under Section 15 of the Consumer Protection Act, 1986 (hereinafter referred to as the 'Act') against the order dated 20.10.2014 in C.C. No. 22 of 28.01.2014 passed by the learned District Consumer Disputes Redressal Forum, Hoshiarpur (in short the 'District Forum') vide which the complaint filed by the respondent/complainant (hereinafter referred as 'complainant') was partly allowed with the directions to the OP to pay Rs. 2 lac as compensation, Rs. 27,287/- as medical expenses and Rs. 20,000/- as litigation expenses.
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2. A consumer complaint was filed by the complainant against the OP on the allegations that she was pregnant and for the purpose of delivery she was got admitted in Swami Premanand Hospital, GT Road, Mukerian on 11.08.2013 vide admission No. 1776/13 wherein the OP was a medical Officer. The complainant was operated upon by the OP on the same date and live female baby was delivered. She was discharged from the hospital on 15.08.2013. The complainant remained under the follow up treatment of the OP and she had gone to the hospital on 19.08.2013 for removal of the stitches. At the time she was having the problem of bleeding. The OP was informed about this problem but the OP stated that it is a normal problem and will be cured shortly. On 07.10.2013, she got scanning from Sukhmani Colour Scanning Centre, Dasuya and it was found that endometrial cavity showed a large heterogeneous echogenic mass of 40*34 mm. However, when during the night, the problem increased, she again contacted OP. At that time, she had shifted to Life Care Hospital, Talwara, Mukerian. The OP again asked her for the scanning and referred the complainant Crystal Diagnostic Centre on 10.10.2013. The perusal of the report revealed that the complainant was found having echorich area anterior to the endometrium- uterine hematoma. Despite the treatment given by the OP, the complainant was still suffering from the same problem. In those circumstances, the complainant should have been referred to some higher institute, but the OP continued the treatment. Faced with this situation, she herself came to Dhami Nursing Home, Hoshiarpur and on the advice of Medical Officer of Dhami Nursing Home, she got MRI done from Raj Scan on 23.10.2013. Its report was as under:
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"Intracavitary area fundal part uterous with signals consistent with blood degradation products likely possibility of sub cube acute hematoma with retained pocs (Placental Tissues)."
After checking the above said position, the Medical Officer of Dhami Nursing Home asked the complainant that this problem cannot be treated with the medicine and she has to go to better institute i.e. PGI or DMC. She had gone to DMC, Ludhiana on 25.10.2013 and on 29.10.2013 she was admitted there vide receipt No. 51619 dated 29.10.2013, CR No. 167153. The treatment given by doctor of DMC should have been given by the OP to the complainant but the said treatment was not given by the OP, therefore, she was guilty of medical negligence while treating the complainant. The perusal of the report showed that she was found to retained products of conception and she was advised for the treatment of Vise "Virually Inspected Suction Evacuation". The complainant spent approximately a sum of Rs. 2 lacs on her admission and treatment due to negligence on the part of the OP. The complainant had approached the OP to redress of her grievance but to no results. Hence the complaint with the direction to the OP to pay sum of Rs. 1,50,000/- on account of mental pain, physical suffering and mental stress, Rs. 6 lacs on account of salary loss of the husband of the complainant, Rs. 1,00,000/- as medical expenses, Rs. 50,000/- on account of depriving of minor of motherly love and affection.
3. The complaint was contested by the OP who filed written reply taking preliminary objections that the complaint was not legally maintainable, there is no relationship between the complainant and the OP as consumer and service provider, the complaint was bad for non-joinder of necessary party. Infact OP was employee Swami Premanand Charitable Hospital, G.T. Road Mukerian, District Hoshiarpur and after pregnancy the complainant used to First Appeal No. 1531of 2014 4 come this hospital for routine check up. On merits, it was denied that the complainant had hired any services from the OP, however, it was admitted that the complainant got herself admitted in Swami Premanand Charitable Hospital, Mukerian, District Hoshiarpur on 11.08.2013 for the delivery and she had delivered a female baby at about 10:11 PM. After delivery, the child was fully fit and fine and she was discharged in satisfactory condition. She again came to the OP on 19.08.2013 for removal of the stitches and at the time she informed regarding the decrease of the milk production. For that purpose, OP prescribed some medicines. At that time she had not complained regarding bleeding or any other problem. She stayed in the hospital for a short period. On 09.10.2013, the complainant again approached OP and complained about the bleeding. OP conducted her blood test and the report was normal. For bleeding, she was prescribed some medicine and done Curettage. The complainant again came to the hospital on 15.10.2013, OP provided the best treatment. It was denied that on account of treatment given by OP the complainant had suffered any problem for which she should have been advised to go to better institute. It was denied that the complainant suffered due to insufficient service of the OP. The OP is qualified gynaecologist and was fully competent and professionally qualified, she had provided the best treatment. Even DMC Hospital, Ludhiana had also provided the same treatment. She was working as gynaecologist for the last 10 years. There was no case of medical negligence. The complaint was without merit and it be dismissed.
4. Parties adduced evidence in support of their contentions. Complainant tendered into evidence affidavit Ex.C-1, bills Ex.C-2 and Ex.C-3, ultrasound scan report Ex.C-4, bill dated 10.10.2013 Ex.C-5, universal lab service report Ex.C-6, Crystal Diagonostic Centre Report Ex.C-6A, Dhami Nursing First Appeal No. 1531of 2014 5 Home prescription slip Mark C-7 and Ex.C-8, Raj 3D Scan 's Receipt dated 23.10.2013 Ex.C-9, its report Ex.C-9A, Report dated 05.12.2013 Ex.C-11, Ultrasound report dated 21.10.2013 Ex.C-12, Dr. Lal Path Labs dated 25.10.2013 Ex.C-13, bill dated 21.10.2012 Ex.C-14, bill Ex.C-15, discharge summary of DMC Ex.C-16, bills of DMC Ex.C-17 to Ex.C-29, Ultrasonography Ex.C-30, pathology report Ex.C-31 and closed the evidence. On the other hand, the OP tendered into evidence affidavit Ex.OP- 1, Certificate Mark OP-2 to Mark OP-4 and closed the evidence.
5. After going through the allegations as alleged in the complaint, written reply filed by OP No. 1, evidence and documents on the record, the learned District Forum found that at the time of operation the OP left behind tissue of placenta which was cause of bleeding and post operatively the OP did not give the best treatment and ultimately she was cured from DMC Hospital, Ludhiana and accordingly, the OP was directed to pay the amount to the complainant as referred above.
6. Aggrieved with the order, the OP/appellant has filed this appeal.
7. We have heard the learned counsel for the parties, have gone through the written statement submitted by the counsel for the appellant and have perused the record
8. It was submitted that there are chances that the placenta is left in the body after the delivery. The treatment given by the DMC Hospital, Ludhiana also revealed retention of products of conception was in the body whereas the OP had treated the complainant to her best ability and in case some product of conception was retained in the body that was the known complication and it is not a case of medical negligence. Counsel for the appellant has also referred to literature i.e. Williams Obstetrics in which Succenturiate Lobe is reproduced as under:-
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Succenturiate Lobe:-
These placentas are a smaller version of he bilobate placenta one or more small accessory lobes develop in the membranes at a distance from the main placenta, to which they usually have vascular connections of fetal origin. Although its incidence has been cited by Benirschke and associates (2006) to be as high as 5 percent, we have encountered these much less frequently. Suzuki and co-workers (2009) noted a twofold higher incidence of succenturiate lobes in twin placentas. The accessory lobe may sometimes be retained in uterus after delivery and may cause serious hemorrhage. In some cases, an accompanying vasa previa may cause dangerous fetal hemorrhage at delivery.
Placenta Accreta, Increta and Percreta These abnormalities are serious variations in which trophoblastic tissues invade the myometrium to varying depths. They are much more likely with placenta previa or with implantation over a prior uterine incision or perforation. Torrential hemorrhage is a frequent complication. (see chap. 35, p 776) Late Postpartum Hemorrhage:-
The American College of Obstetricians and Gynaecologists (2006) defines secondary postpartum hemorrhage as bleeding 24 hours to 12 weeks after delivery. Clinically worrisome uterine hemorrhage develops within 1 to 2 weeks in perhaps 1 percent of women. Such bleeding most often is the result of abnormal involution of the placental site. It occasionally is caused by retention of a placental fragment. Usually the retained piece undergoes necrosis with deposition of fibrin and may eventually form a so-called placental polyp. As the eschar of the polyp detaches from the myometrium, First Appeal No. 1531of 2014 7 hemorrhage may be brisk. Demers (2005) and Salman (2008) and their associates have described delayed postpartum hemorrhage caused by von Willerbrand disease (see Chap. 51, P. 1097)
9. Now we have to consider the case of the complainant in the background of above referred medical literature. It is clear from the pleadings that the delivery of the complainant was LSCS (Lower Segment Caesarean Section) where the delivery of the baby is not normal but infant is surgical removed from the uterus then there should be no chance of retention of placenta. In case, the baby would have been born vaginally then possibility of some retention of products of conception or tissue of placenta may be given but when the baby was born with LSCS, the uterus is open and there is minimum possibility of retention of product of conception unless and until the care and precaution is not taken. Therefore, in case, the delivery was LSCS, then there was no reason for retention of product of conception in the uterus and if retained, then there is indication of negligence on the part of the attending doctor. It was also stated by the complainant that when she came to the OP on 19.08.2013, then there was problem of bleeding. At the time no proper tests were got conducted by the OP and she just gave some medicines and problem did not solve. Then she again reported the OP on 19.10.2013, again some medicines were prescribed. When she reported another hospital at Hoshiarpur, they referred her to better institute P.G.I. or DMC, Ludhiana and the complainant approached DMC, Ludhiana. She was admitted there till 29.10.2013 under the Management of Dr. Ashima Taneja. Said doctor appeared in the witness box as Ex. CW/2 and took the case of the complainant as the case of retention of Placenta. She referred her for blood tests and ultrasound and in the ultrasound report the diagnosis was "Product of Conception' i.e. some First Appeal No. 1531of 2014 8 part of Placenta was left after LSCS and then Visually Inspected Suction Evacuation was done which means cleaning of uterus under vision on 29.10.2013 and products were removed and them sent to histopathalogy test. It was observed that due to retention of product of conception, the complainant continued bleeding after LSCS for two months which resulted her weakness. In the cross examination, nothing material had come to support the plea of the OP. From the entire evidence, it is clear that when LSCS was conducted then at the time product of conception was retained in the uterus which caused bleeding and ultimately these were removed from the DMC, Ludhiana on 29.10.2013 by VISE. This method was never adopted by the OP and she had given only the medicines. Therefore, firstly, she is negligent when she left the product of conception in the uterus when it was an open surgery then this product should not retain in the uterus in case some care and caution had been taken at the time of LSCS and in post operative also, proper method was not taken to remove it. Due to negligence on the part of the OP, the complainant had to go to Life Care Hospital, Hoshiarpur and then to DMC, Ludhiana and in that process he had to spend a sum of Rs. 2 lacs. Counsel for the appellant has referred some judgments in the written arguments i.e. Jacob Mathew Vs. State of Punjab and another that medical board of experts/doctors should have been constitute. But no such application was given by the OP to refer the matter to any Medical Board or some other hospital. Court has examined Dr. Sukhpreet Kaur Dhami as well as Dr. Ashima Taneja who in their written statement confirmed that it was the case of retention of placenta, therefore, when this evidence was not rebutted rather the OP also gave the treatment for that, although she gave only the medicines and did not adopt the proper procedure to clean the uterus by VISE. In view of this evidence, there is no necessity First Appeal No. 1531of 2014 9 to constitute any medical board for expert opinion. She has also referred to another judgment titled as "Philips India Limited Vs Kunju Punnu" (AIR 1975) Bombay 306 in which it was observed that the principal of law of medical negligent should be based on cogent evidence and not on the basis of conjectures and surmises. She has also referred the judgment reported as "Malay Kumar Ganguly Vs. Sukumar Mukhrjee" (2009) CPJ 17 (SC) in which it was held that in the case of medical negligence, the court would be slow in contributing negligence on the pat of doctor, if he is performing his duty to the best of his ability. She has referred another judgment titled as "Patel Ramubhai Vs. India Air Lines 1991 CPJ 511 Gujarat in which it was held that in case other doctor has adopted the similar treatment then it is not case of medical negligence. The basic principal for medical negligence has been settled in case Bolam's case i.e. Bolam v. Friern Hospital Management Committee, (1957) 2 ALL ELR 118. In case we go through these basic principles, the doctor can be negligent in case he has not done anything which should have been done by her. In the present case after operating the LSCS, it was her duty to see whether the remains of conception does not remain in the uterus but she did not check the patient properly and remains of conception retained in the uterus which later on caused the problem of bleeding and ultimately these were removed from DMC, Ludhiana by adopting the procedure of VISE. The plea of the appellant that these are known complications of delivery. We would have agreed to this plea of the appellant, in case, the delivery would have been vaginal i.e. normal delivery. But in the case of LSCS, the uterus is open, then it is very easy for the doctor to check whether the remains of conception/placenta is there or not and in case some reasonable care would have been taken by the doctor then this can be removed by the time, then the First Appeal No. 1531of 2014 10 patient should have not been suffered from the problem which she faced later on. Prima facie, it is the case of medical negligence.
10. We are of the opinion that the findings recorded by the District Forum are correct. We do not agree with the pleas taken by the appellant/OP that the findings so recorded by the District Forum are incorrect. The order so passed by the District Forum is correct and the same is upheld. We do not see any merit in the appeal and the same is hereby dismissed.
11. The appellant had deposited amounts of Rs. 25,000/- and Rs. 1,00,000/- with this Commission. Both these amounts with interest accrued thereon, if any, be remitted by the registry to respondent/complainant by way of a crossed cheque/demand draft after the expiry of 45 days, subject to stay, if any, by the higher Fora/Court.
12. Remaining amount shall be paid by the appellant to respondent within 30 days from the receipt of the copy of the order.
13. The arguments in this appeal were heard on 20.07.2015 and the order was reserved. Now the order be communicated to the parties as per rules.
14. The appeal could not be decided within the statutory period due to heavy pendency of Court cases.
(GURCHARAN SINGH SARAN) PRESIDING JUDICIAL MEMBER (JASBIR SINGH GILL) MEMBER (MRS. SURINDER PAL KAUR) MEMBER August 3, 2015.
Rupinder First Appeal No. 1531of 2014 11