State Consumer Disputes Redressal Commission
Mandeep Singh vs Dr. Rupinder Kaur on 20 April, 2016
2nd Additional Bench
STATE CONSUMER DISPUTES REDRESSAL COMMISSION, PUNJAB
DAKSHIN MARG, SECTOR 37-A, CHANDIGARH
Consumer Complaint No. 37 of 2012
Date of institution:16.5.2012
Date of Decision:20.4.2016
1. Mandeep Singh S/o Gurdev Singh,
2. Avneet Kaur(minor)
3. Anureet Kaur(minor)
Complainants No. 2 & 3 represented through their father Mandeep
Singh (as per order dated 11.2.2014)
All residents of House No. 20214, Gali No. 17, Guru Teg Bahadur
Nagar, Bathinda, Tehsil and District Bathinda.
Complainants
Versus
1. Dr. Rupinder Kaur Romana, Romana Hospital, Street No. 10, Near
St. Xavier School, Bathinda, Tehsil and District Bathinda.
2. Dr. Kumkum Awasthi, Gynecologist (Team Incharge) C.M.C.
Hospital, Ludhiana.
3. Dr. Navjot Singh Sidhu (Incharge Post Care Team) I.C.U.-I, C.M.C.
Ludhiana.
4. The New India Assurance Co. Ltd., Malout Branch, Bathinda.(added
vide orders dated 21.1.2013)
Opposite Parties
Consumer Complaint under the Consumer
Protection Act, 1986.
Quorum:-
Shri Gurcharan Singh Saran, Presiding Judicial Member
Shri Jasbir Singh Gill, Member
Present:-
For the complainant : Sh. Binderjit Singh, Advocate with
Sh. G.S. Bandi, Advocate
Consumer Complaint No. 37 of 2012 2
For Op No. 1 : Sh. Mukand Gupta, Advocate
For Op Nos. 2&3 : Sh. B.L. Saini, Advocate with
Sh. Ravi Son, L.O.
For Op No. 4 : Sh. Vinod Chaudhary, Advocate
Gurcharan Singh Saran, Presiding Judicial Member
ORDER
Complainant Mandeep Singh has filed this complaint under the Consumer Protection Act, 1986 (for short 'Act') against opposite parties(hereinafter referred as Ops) on the averments that his wife of Navjeet Kaur conceived twins out of matrimonial relations and he alongwith his wife consulted Op No. 1 in the month of December, 2010 regarding the condition of his pregnant wife and further medical check-up or health care and supervision. On 12.1.2011, an Ultrasound was conducted by Op No. 1 when the fetus was about 9 weeks and twins were confirmed. The expected date of delivery was given as 16.8.2011. After that Op No. 1 continued the supervision. On 5.2.2011 an other Ultrasound was conducted by Op No. 1 in which fetus was stated to be healthy. On 13.3.2011, another ultrasound was got conducted by Op No. 1 in which the fetus was stated to be in healthy condition. After that Op No. 1 did not recommend for any other ultrasound test. Although wife of the complainant(hereinafter referred as 'patient') attended Op No. 1 on 23.4.2011 and 10.5.2011. However, in the month of June, 2011, some problem started with the health of patient and when they consulted Op No. 1, she assured that it was normal and there was no need for test and ultrasound. Op No. 1 did not take the problem of the patient seriously and dealt with in a casual manner. When the Consumer Complaint No. 37 of 2012 3 complainant alongwith his wife visited Op No. 1 on 7.7.2011 then Op No. 1 got conducted laboratory tests and from the said test, it was revealed that she was suffering from Jaundice. Patient became nervous as it was not detected at an initial stage. In case some medical test regarding same would have been conducted at the initial stage then it would not have reached at an advanced stage. Being panicky and confused, Op No. 1 referred the patient to CMC & Hospital, Ludhiana and she was got admitted there on the same day. Seeing her critical condition, she was operated for caesarean section(for short LSCS) and she delivered twin babies on 9.7.2011. Thereafter she remained admitted in ICU and ultimately patient died on 18.7.2011. Due to callous behaviour of Op No. 1, Jaundice was not detected at the initial stage and no ultrasound was got conducted in between 13.3.2011 to 7.7.2011. It was further alleged that complicity of CMC, Ludhiana Op No. 3 could not be ascertained in complete terms as they refused to furnish the record pertaining to the patient admitted vide ID Unit No. C7325518 dated 7.7.2011. Patient was 32 years old in a very good health, well qualified as M.Sc. Math, B.Ed. and was selected for the post of Clerk in the Food and Supply Department in the pay scale of 5910-20800 and she would have served for a period of 28 years. Complainant spent a sum of Rs. 6 lacs on the treatment of the patient. Aforesaid act and conduct of Ops amounted to unfair trade practice, wilful negligence and deficiency in service on their part and accordingly, the complainant claimed a sum of Rs. 1 Crore as compensation in lumpsum regarding expenses of Consumer Complaint No. 37 of 2012 4 treatment, mental loss and economic loss due to non completion of Government Service and for love and affection.
2. Complaint was contested by Ops. Op No. 1 in its written reply took the preliminary objection that complaint is not maintainable in view of the judgment of the Hon'ble Supreme Court in "Martin F D'souza Vs. Mohd. Ishfaq" reported in 2009(3) SCC 1 under which before entertaining the complaint, it was required to be referred to the Committee of competent Doctors to prima-facie make out a case for any medical negligence; there is no cause of action to file this complaint against Op No. 1 as Op No. 1 is/was not guilty of any negligence for causing the death of patient as she had symptoms of Jaundice for the first time on 7.7.2011, when she was advised for various blood tests including liver function test and patient was declared a case of acute fatty liver of pregnancy(AFLP), which is a rare disease and accordingly, the patient was referred to tertiary institution like CMC, Ludhiana and she delivered twin baby on 9.7.2011 and remained under treatment and supervision of Doctor and Medical Team of CMC Hospital, Ludhiana till 18.7.2011 where she died. It was denied that Op No. 1 was casual in attending whenever patient visited her for any consultation. Op No. 1 made the correct diagnosis and advised the patient according to standard medical norms and protocol. Therefore, Op No. 1 is not guilty of any medical negligence or unfair trade practice or deficiency in service. Op No. 1 is a well experienced, well reputed Gynaecologist in Bathinda having qualification of MD (Gyne); complaint is an abuse of process of law and no cause of action had arisen to the complainant Consumer Complaint No. 37 of 2012 5 to file complaint against Op No. 1, therefore, complaint is liable to be dismissed under Section 26 of the Act and that complaint is bad for non-joinder of necessary parties. On merits, it was admitted as a matter of record that patient was consulting Op No. 1 upto 7.7.2011. Ultrasounds were conducted on 12.1.2011, then on 5.2.2011 and 13.3.2011, which showed twin foetuses in healthy condition. Even in 22nd week of pregnancy, ultrasound was normal and both the fetus were found to be a normal and no congenital abnormality was detected. She had visited Op No. 1 on 23.4.2011 and 10.5.2011. She did not feel any necessity for getting ultrasound whereas some other test, just like haemoglobin, urine test were advised. There was no itching complaint and only complaint was pain in abdomen and discomfort was reported, which is routine symptoms of twin pregnancy. On that day, there was no indication of jaundice even as per the test report, no further clinical investigation was required. Patient did not visit Op No. 1 from 30.6.2011 to 7.7.2011 as there was no serious problem to the patient, otherwise she would have visited Op No. 1. On 7.7.2011, major complaint of the patient was swelling over body for the last 2 days. Op No. 1 immediately examined the patient and found symptoms of Jaundice, therefore, she immediately prescribed blood test. On the basis of test, she was diagnosed as pregnancy with jaundice. It was denied that Op no. 1 had become panicky and nervous, therefore, she had referred the patient to CMC, Ludhiana. Op No. 1 is in active practice for the last 24 years, therefore, no question arises to become panicky or nervous. Seeing the condition of the patient, she was referred to Consumer Complaint No. 37 of 2012 6 tertiary hospital i.e. CMC, Ludhiana and she was taken care on the same day, therefore, there was no medical negligence on the part of this Op. On 7.7.2011, the blood test of the patient showed the jaundice was of moderate severity i.e. 9.2 mg%. Patient remained under treatment with CMC Ludhiana upto 18.7.2011 and if anything has gone wrong with the treatment of patient in CMC, Ludhiana, Op No. 1 is not responsible for that. Accordingly, it was submitted that there was no case of medical negligence, unfair trade practice or deficiency in service on the part of Op no. 1. Complaint is without merit, it be dismissed.
3. Op Nos. 2 & 3 in their written reply took the preliminary objections that complaint does not disclose any cause of action against Op Nos. 2 & 3 as complainant himself has stated in para No. 7 that after giving the birth to the twins, patient succumbed to multisystem failure on 18.7.2011. Patient was treated by well qualified and experienced Doctors. The treatment which is universally given all over the world was given to the patient, therefore, there was no negligence on the part of Op Nos. 2 & 3. Op Nos. 2 & 3 are working Doctors of CMC Hospital and that complaint is bad for non-joinder of CMC Hospital, Ludhiana. On merits, it was submitted that as per the record file, a 32 years old pregnant lady, Navjeet Kaur with twin pregnancy (34 weeks gestation) was brought to CMC Hospital, Ludhiana on 7.7.2011 with complaint of fever and jaundice for the last 5-6 days, swelling of feet and breathlessness for 3 days and drowsiness for 1 day prior to coming to the hospital. On examination, she was drowsy but arousable, she had jaundice, facial Consumer Complaint No. 37 of 2012 7 puffiness(swelling), asterisis (flapping tremors), bilateral pedal edema(swelling of feet). Accordingly, she admitted under medicine team after she was checked by Gynaecology team in casualty. Ultrasound examination showed twin pregnancy. Blood investigations revealed that she had raised white cell count(leucocytosis), deranged bleeding parameters (coagulopathy) with deranged kidney and liver function. She was started on hepatic coma regimen & medicines with L-Ornithine L-Aspartate, lactulose, dextrose, albumin and vitamin K injection alongwith broad spectrum antibiotics (Meropenem and Teicoplanin) and Sodium bicarbonate infusion. Patient was seen by Gastroenterologist for liver disease and nephrologist in view of kidney dysfunction and resulting metabolic acidosis. The critical condition and poor prognosis of the patient was explained to the husband of the patient. On 8.7.2011, patient started labour pain and she was shifted to labour room for further monitoring and expert management by Gynaecologist. She was tried for spontaneous vaginal delivery because of (a) First Twins Cephalic Presentation and (b) deranged coagulation parameters. She was augmented after four hours but she did not progress in the labour. On 9.7.2011, she was taken up for LSCS by the Gynaecology Team after taking patient high risk consent from the relative of the patient. After surgery, she was shifted to Intensive Care Unit (ICU) and was given Blood and Blood products in view of continuing coagulopathy. Her blood investigation continued to be deranged and on 12.7.2011, her condition further deteriorated and she required non-invasive ventilation(BIPAP) and abdominal distension was noticed with sluggish bowel sounds. Repeat Consumer Complaint No. 37 of 2012 8 Ultrasound showed 1 to 1.5 litre of fluid collection in the abdomen. Both surgical as well as Gynaecological consultation were sought. However, the condition of the patient continued to be deteriorated. On 13.7.2011, she started oozing from the suture site. On investigation, blood parameters were deranged and she was transfused blood and blood products but she did not showed any improvement. Therefore, she was taken up for repeat laprotomy upon which no active bleeding site was identified and 1.2 litre of hemorrhagic peritoneal fluid (blood stained) was removed and a drain was placed in situ (left in abdomen). She was bleeding inside the peritoneal cavity due to severe coagulopathy (deranged bleeding parameters), due to fulminant liver failure. She was shifted back to ICU and put on ventilation support. She had hypotension (fall in blood pressure) for which she was given intravenous fluids followed by ionotropic support to bring up the blood pressure. In view of deranged bleeding parameters, anaemia and low platelet count (thrombocytopenia), she received multiple blood and blood products transfusions. On next day, her urine output dropped and she continued to have blood stained discharge from the drain. Nephrology consultation was sought for haemodialysis after giving fluid challenge and lexis infusion. She was continued to be managed conservatively. On 17.7.2011, the drain showed some clearing but her renal and hepatic parameters continued to be deranged and her general condition continued to be critical. During haemodialysis on 18.7.2011, her blood pressure further dropped and she required 3 ionotropic supports. Post haemodialysis, she had a cardiac arrest for which she Consumer Complaint No. 37 of 2012 9 was given cardio pulmonary resuscitation but she could not be revived. Since the patient was brought to CMC, Ludhiana in a very critical condition, she was given the best possible treatment for her illness during the period she stayed in the hospital. She was given treatment by various teams i.e. medicines, gynaecology, surgery, gastroenterology, haematology, nephrology and intensive care specialists from time to time. Therefore, there was no negligence or deficiency in service on the part of treating Doctors of CMC, Ludhiana. Patient had died due to her critical condition and illness. Op Nos. 2 & 3 alongwith other specialists and available machinery and techniques, give their best but they could not save the life of the patient. It was denied that CMC refused to furnish the record, as per rules of the hospital, the record of all treatment details are provided, if a written request was submitted by the relative of the patient. Hospital never refused to supply any record to the complainant; because the complainant never applied for the same. There was no case of any unfair trade practice, medical negligence or any deficiency in service. Complaint against these Ops is without merit, it be dismissed.
4. Op No. 4 in its reply took the preliminary objections that the complaint is mis-conceived as the same was filed with ulterior motive. On merits, it was stated that the treatment was given according to the protocol and medical standards. The disease Jaundice manifests gradually and it was beyond comprehension as to how the complainant can impute occurrence of jaundice owing to treatment taken from Ops. The allegations are bereft of any merit. Therefore, complaint is without any merit, it be dismissed. Consumer Complaint No. 37 of 2012 10
5. The parties led their respective evidence in support of their contentions.
6. In support of his allegations, complainant had tendered into evidence Ex.CW-1/A the examination in chief by way of affidavit by Mandeep Singh dated 11.03.2013, Ex.CW-1/B the examination in chief by way of affidavit by Gurdeep Kaur dated 11.03.2013 and documents Ex.C/1 OPD slip Ramana Hospital, Bathinda dated 14.12.2010, Ex. C-2 photocopy of film and ultrasound report dated 12.01.2011, Ex. C/3 photocopy of film and ultrasound report dated 05.02.2011, Ex. C/4 photocopy of film and ultrasound report dated 13.03.2011, Ex.C/5 photocopy of OPD slip Ramana Hospital, Bathinda dated 23.04.2011, 20.06.2011 and 30.06.2011. Ex.C/6 photocopy of OPD slip Ramana Hospital, Bathinda dated 10.05.2011 and 28.05.2011, Ex.C/7 photocopy of OPD slip Ramana Hospital, Bathinda dated 07.07.2011, Ex.C/8 lab report dated 07.07.2011 by Jyoti Clinical Lab indoor Ramana Hospital, Bathinda, Ex.C/9 lab report dated 07.07.2011 in CMC and Hospital Ludhiana, Ex.C/11 Birth Certificate of first twin baby dated 13.07.2011, Ex.C-12 Birth Certificate second twin baby dated 13.07.2011. Ex .C/13 death certificate of Navjeet Kaur dated 03.08.2011, Ex.C/14 list of Department of Food and Supplies Punjab, Gazette for Clerks exam held on 08.05.2011, Ex.C/15 appointment letter of Navjeet Kaur, Ex.CW-1/C16 dated 05.02.2011 OPD slip, Ex.CW-1/C17 OPD slip dated 11.02.2011, Ex.CW-1/C18 Jyoti Clinical Lab Report dated 14.12.2010, Ex.CW-1/C19 Jyoti Clinical Lab report dated 05.03.2011, Ex.CW-1/C20 Jyoti Clinical Lab report dated 26.03.2011, Ex.CW- Consumer Complaint No. 37 of 2012 11 1/C21 Jyoti clinical lab report (Haematology) dated 13.04.2011, Ex.CW-1/C22 Jyoti clinical lab report dated 23.04.2011, Ex.CW- 1/C23 Jyoti clinical lab report dated 10.05.2011, Ex.CW-1/C24 Jyoti clinical lab report dated 20.06.2011, Ex.CW-1/C25 Jyoti lab Haematology report dated 20.06.2011, Ex.CW-1/C26 Jyoti lab urine report dated 20.06.2011, Ex.CW-1/C27 OPD slip of Romana Hospital, Bathinda, Ex.CW-1/C28 OPD slip backside of letter pad of Romana Hospital, Bathinda, Ex.CW-1/C29 certified photocopy of statement dated 06.11.2013 of J.S. Romana Ultrasound Eco and Colour Doppler Centre, Mall Road, Bathinda in the Court of Hon'ble Judicial Magistrate Ist Class, Bathinda, Ex.CW-1/C30 certified photocopy of statement dated 06.04.2013 of Tarsem Singh Proprietor/Technologist Clinical Lab indoor Romana Hospital, Bathinda in the Court of Hon'ble Judicial Magistrate Ist Class, Bathinda, Ex.CW-1/C31 photocopy of Matriculation Certificate issued from Punjab School Education Board of Navjeet Kaur Since deceased bearing Roll no.567114 dated 07.01.1997 showing date of birth 19.12.1979, Ex.CW-1/C32 photocopy of degree of B.Sc. from Punjabi University, Patiala of Navjeet Kaur since deceased bearing roll no.50780 dated 12.12.2001, Ex.CW-1/C33 Provisional result intimation of M.Ed Examination from Punjabi University, Patiala bearing roll no.9409 dated 24.10.2011, Ex.CW-1/C34 letter dated 02.12.2013 from Director, Department of Health and Family Welfare, Punjab, Chandigarh ordering constitution of medical report, Ex.CW- 1/C35 letter dated 14.01.2014 from District Family Welfare Officer cum Enquiry Officer, Sangrur for conducting enquiry by Medical Consumer Complaint No. 37 of 2012 12 Board, Ex.CW-1/C36 letter dated 19.02.2014 from District Family Welfare Officer cum Enquiry Officer, Sangrur for conducting enquiry by Medical Board, Ex.C-37 letter dated 19.02.2014, Ex.C-38 letter dated 14.03.2014, Ex.C-39 letter dated 27.03.2014, Ex.C-40 letter dated 16.04.2014, Ex.C-41 letter dated 02.12.2013, Ex.C-42 application dated 26.05.2014, Ex .C-43 application dated 21.02.2013, Ex.C-44 application dated 21.02.2013, Ex.C-45 letter dated 12.03.2013, Ex.C-46 enquiry proceedings dated 09.04.2013, Ex.C-47 enquiry proceedings dated 09.04.2013, Ex.C-48 enquiry proceedings dated 23.04.2013, Ex.C-49 enquiry proceedings dated 23.04.2013, Ex.C-50 enquiry proceedings dated 10.05.2013, Ex.C-51 enquiry proceedings dated 23.04.2013, Ex.C-52 enquiry proceedings dated 23.04.2013, Ex.C-53 enquiry proceedings dated 23.04.2013, Ex.C-54 enquiry proceedings dated 18.06.2013, Ex.C-55 statement dated 10.05.2013, Ex.C-56 statement dated 10.05.2013, Ex .C-57 cross- examination dated 10.05.2013, Ex.C-58 statement dated 23.04.2013, Ex.C-59 enquiry proceedings dated 18.06.2013, Ex.C-60 statement dated 09.04.2013, Ex.C-61 enquiry proceedings dated 10.05.2013, Ex.C-62 statement dated 18.06.2013, Ex.C-63 enquiry report, Ex .C- 64 Diary No.1591 dated 28.02.2013, Ex.C-65 letter dated 10.07.2014, Ex.C-66 attendance sheet, Ex.C-67 application dated 18.10.2013, Ex.C-68 Obstetrics from medical books, Ex.C-69 application dated 18.10.2013, Ex.C-70 letter dated 02.12.2013, Ex .C-71 application dated 05.02.2014, Ex.C-72 application dated 25.02.2014, Ex.C-73 prescription slip dated 03.10.2011. Op No. 1 had tendered into evidence affidavit of Dr. Rupinder Kaur Romana Ex.O-1/A alongwith Consumer Complaint No. 37 of 2012 13 documents ins. Policy Ex.OP-1/1, medical prescription slip Ex.OP- 1/2, Inquiry report dated 22.08.2013 Ex.OP-1/3, Certificates Ex.OP- 1/4, Medical Journals Ex.OP-15, Inquiry report dated 27.11.2014 Ex.OP-1/6. Op No. 2 had tendered into evidence Ex.OP-2/A affidavit of Dr. Kumkum Awasthi, Professor and head, Ex.OP-2/1 Bio-data of Dr. Kumkum Awasthi, Ex.OP-2/2 curriculum vitae of Dr. Navjot Singh, M.D., Ex.OP-2/3 certified copy of medical record of the patient Navjeet Kaur, age 32, female resident of Bathinda, affidavit of doctor Navjot Singh Sidhu, Professor Department of Medicine Christian Medical College and Hospital, Ludhiana as Ex.OPW-2/4, his biodata as Ex.OP2/5, additional affidavit of Dr. Kumkum Avasthi, as Ex.OP2/6, inquiry report dated 03.09.2013 given by Civil Surgeon Ludhiana, as Ex.OP2/7, inquiry report dated 17.10.2014 given by Civil Surgeon Sangrur as Ex.OP2/8. Op No. 4 had tendered affidavit as Ex.D4/1.
7. We have heard the counsel for the parties and have carefully gone through the averments made in the complaint, written version, evidence and documents on the file and have also gone through written arguments submitted by the parties.
8. It is an admitted fact that patient(wife of the complainant) was pregnant. For medical check-up of health care and supervision, she was taken to Op No. 1, who is Gynaecologist. However, for the first time she had consulted Op No. 1 on 14.12.2010(Ex. C-1) when some medicines were prescribed by the Doctor. On 12.1.2011, Ultrasound was recommended and as per Ultrasound report Ex. C- 2/1, it was found twin fetus. Ultrasound was repeated on 5.2.2011 Consumer Complaint No. 37 of 2012 14 and both the fetus were reported to be normal. Third Ultrasound was repeated on 13.3.2011 and both the fetus were reported to be normal. On 23.4.2011(Ex. C-5) patient reported to Op No. 1 and some medicines were prescribed alongwith test. On 30.6.2011, patient came with some complaint of some pain in abdomen and abdomen distension. Some medicines were given and then she reported to Op No. 1 on 7.7.2011. She had complained about swelling all over the body for the past two days. Some tests were prescribed including (LFT) and on the basis of these tests, it was reported that she was suffering from jaundice and was declared a case of AFLP. Seeing the condition of the patient critical, she was referred to Dr. K.K. Awasthi in CMC Hospital, Ludhiana.
9. Now the allegations of the counsel for the complainant are that after 13.3.2011, Ultrasound was not repeated and Jaundice was not detected at an earlier stage. In case jaundice would have been detected at earlier stage then it would not have been so serious causing life threat to the life of patient and under that disease, the patient had died.
10. Now we have to see what is the purpose of Ultrasound and whether there was any medical negligence on the part of Op No. 1 that jaundice could be detected at an earlier stage. The importance of ultrasound has been referred by him in the literature as under:-
"Imaging in Obstetrics, Amniocentesis and Guides to Clinical Tests Safety of ultrasound: Ultrasound is an essential tool in the management of almost every pregnancy. The effects of Consumer Complaint No. 37 of 2012 15 ultrasound on tissues are: temperature elevation, formation of micro bubbles and cavitation. However, there is no clear evidence till date that ultrasound examination during pregnancy is harmful. Ultrasound should be done with valid medical indications and with shortest duration possible to avoid unnecessary exposure specially with the Doppler. Doppler ultrasound require high power output. The upper limit of power what is considered safe is 1000 mW/cm². Therefore ultrasound should be judiciously used specially the Doppler one."
11. This literature also indicates that Ultrasound should be dealt with valid medical indications and when shortest duration to avoid unnecessary exposure especially with Doppler. Counsel for Op No. 1 stated that ultrasound imaging is a non-invasive medical test that helps physician diagnosing and medical condition of patient. In a Doppler ultrasound is a special ultrasound technique that allows the physician to see and evaluate blood flow through arteries and veins in the abdomen, arms, legs, neck etc. Ultrasound examinations can help to diagnose a variety of conditions and to assess organ damage following illness. Although in the twin pregnancy, the ultrasound may be repeated on monthly basis but it depends about the condition of the babies. Op No. 1 had repeated ultrasound for three months consecutively and medical condition of the twins was normal. It is not necessary that medical condition of the babies can be assessed only by ultrasound. The Doctors specialist in the field having experience and specially in the case of Op No. 1, she was having 24 years experience, can judge the medical condition of the babies by physical Consumer Complaint No. 37 of 2012 16 examination until and unless some special report is given by the patient and in case some specific report would have been given by the patient then in case ultrasound was needed and it would not have been done then it could be stated that there was negligence on the part of treating Doctor but here the main problem arose from jaundice in pregnancy, which ultimately turned to be a fatal, taking the life of the patient otherwise twin babies, who took birth on 9.7.2011 are safe and healthy. Therefore, merely because of the fact that in case of twin babies, ultrasound should be done every month is not necessary. The complainant is required to prove what was the fall out upon the medical condition of the mother and the babies on account of non-performance of ultrasound but no such condition or circumstances have been brought on the record that in case ultrasound would have been conducted it would have saved the patient from AFLP. Jaundice is altogether a different aspect and it cannot be co-related with ultrasound because ultrasound is just an imaging, which helps Physician to know the condition of the patient or the babies. Since no adverse report was made by the patient when the patient attended Op No. 1 on 3.4.2011 and 10.5.2011 Exs. C-4, C-5, C-5(i), ultimately she had reported with some abdominal pain on 30.6.2011 and some tests were prescribed. On that day also no symptoms of jaundice were reported. These symptoms were detected by the Doctor only on 7.7.2011 when the patient reported for swelling and itching on whole body. LFT and other related tests were done from which she was diagnosed case of AFLP, therefore, we are of the opinion that in case in the month of April or May, no ultrasound was Consumer Complaint No. 37 of 2012 17 conducted it will not have any adverse effect on the treatment and health condition of the patient and the babies, therefore, Doctor cannot be held liable for medical negligence for not conducting the repeated ultrasound in the month of April and May, 2011.
12. The importance of the ultrasound is also relevant because in twin pregnancy, there are 15 to 29% chances of discordant growth and in case repeated ultrasound would have been after 13.3.2011 then discordant growth between twins could have been checked. There is no denial of the fact that ultrasound is important and in case it is repeated, it could check the discordant growth between twins. It is general principle. However, what is the problem in the case in hand. In the entire complaint, the complainant has not stated that there was discordant growth between twins. Even in the evidence produced on the record by the complainant, no document has been placed on the record that at the time the patient was under treatment with Op No. 1 or after the delivery, there was major discordant growth between the twins, otherwise, there is every possibility and it is natural difference in the development of two fetus. Therefore, without any allegation in the complaint and specific evidence on the record, it cannot be said that Op no. 1 was medically negligent, not to go for repeated ultrasound to check the discordant growth. As referred above, ultrasound were conducted on 12.1.2011, 5.2.2011, 13.3.2011 and she was physically checked by the Doctor when she had come for consultation with Op No. 1 on 23.4.2011, 10.5.2011 and 30.6.2011. When no major discordant growth in the twins has been explained or proved, then no allegation against Op No. 1 can be Consumer Complaint No. 37 of 2012 18 proved that she was negligent for not asking for Ultrasound or that there was any discordant growth. After the births, the twins are living normal life. No medical negligence can be assigned to Op No. 1 not to go for repeated ultrasound to check discordant growth between the twins.
13. It has been orally argued by counsel for the complainant as well as put in written arguments that on 30.6.2011, the health of the patient deteriorated and the problem continuously persisted. As she was having loss of hepatitis, etching on whole body and there was pain in her abdomen. The complainant alongwith his wife and mother consulted Op No. 1 and reported the said circumstances to her. She did not take it seriously and in a callous manner told the complainant, his wife that these problems are normal in pregnancy and did not recommend the required clinical test/ultrasound. However, the condition of the patient deteriorated. Even in the OPD slip dated 30.6.2011, site of abdomen pain, duration of pain, character of pain and radiation has not been mentioned and then she reported to Op No. 1 on 7.7.2011 when condition became critical and then some clinical tests were recommended by Op No. 1 on the basis of which it was diagnosed that she was suffering from AFLP, therefore, Op No. 1 was again negligent not to recommend clinical test/ultrasound on 30.6.2011 when the matter was reported to Op no. 1 as referred above. It has been so stated by the mother of the complainant in her affidavit tendered on the record as Ex. CW-1/B and affidavit of complainant Ex. CW-1/A. However, the counsel for Op No. 1 has argued that when the patient had reported her on Consumer Complaint No. 37 of 2012 19 30.6.2011 as per OPD slip Ex. CW-1/5(ii), she had only complaint of abdominal pain. Patient was examined but she did not find any obvious sign of any other disease but found that uterus was over distended (due to twin pregnancy). Pv examination, the cervix was found to be closed/unaffected. Urine test was advised for assessment of colour, albumin, sugar and infection and there was no indication of jaundice as on 30.6.2011, therefore, no further investigation was required. The said report is Ex. C-2/1 and report of the urine examination is as under:-
"Routine Urine Examination Physical Examination:
Colour Yellow
Appearance Clear
Volume 10 ml
pH Acidic
Specific Gravity
Chemical Examination:
Albumin Nil
Sugar Nil
Phosphate
Bile Salts
Bile Pigments
Microscopic Examination:
Epithelial Cells 4-6/HPF
Pus Cells 1-2/HPF
RBCS Nil
Consumer Complaint No. 37 of 2012 20
Casts Nil
Crystals Nil"
In case there would have been any problem of jaundice on 30.6.2011 then indication would have come in the urine test. The symptoms as stated by the complainant in his written arguments and the affidavit are not corroborated from the OPD slip. In case the patient was visiting, Op No. 1 for the last more than six months in case other indications were recorded by the Doctor, we do not see any reason that Doctor will not record the symptoms as stated by the complainant in his affidavit in case there would have been any indication of that. Therefore, any evidence over and above, the medical record can be afterthought. When the patient was referred to CMC Hospital, Ludhiana on 7.7.2011, what was the condition of the patient and what were the findings given by CMC Hospital, Ludhiana as on 7.7.2011. In the admission record and as reported by Dr. K.K. Awasthi in his affidavit Ex. Op-2/A, it was referred that there was complaint of fever and jaundice for the last 5-6 days, swelling of feet and breathlessness for the last 3 days and frowziness for 1 day prior to coming to Op Nos. 2 & 3. It is so mentioned in the patient record Ex. Op-2/3, therefore, from the record of Op No. 1 and record of Op Nos. 2 & 3, it is not corroborated that patient was facing any problem of jaundice as on 30.6.2011. Therefore, the complainant has not able to bring on the record any cogent evidence that the findings so recorded by Op No. 1 as on 30.6.2011 are incorrect findings because the findings so recorded by Op No. 1 have been corroborated by Op Nos. 2 & 3 and as stated above, Op No. 1 does not have any reason not to report Consumer Complaint No. 37 of 2012 21 symptoms of jaundice in case other indications were given by him in her report OPD slip. Therefore, the allegations of the complainant in his affidavit and affidavit of his mother i.e. of 30.6.2011, there was symptoms of jaundice and Op No. 1 failed to report it, which deteriorated the condition of the patient are incorrect and are not corroborated on the basis of medical record of the patient maintained by Op Nos. 1 and Op Nos. 2 & 3. On 7.7.2011, when the patient reported to Op No. 1, some clinical tests were prescribed including LFT on the basis of which the patient was diagnosed suffering from Jaundice and seeing the condition of the patient, she was referred to tertiary hospital i.e. CMC Hospital, Ludhiana and after that the patient was not attended by Op No. 1, therefore, in case the patient was in a critical condition, there was nothing bad to refer the patient to tertiary hospital. Therefore, we are of the opinion that Op No. 1 had given the treatment to the patient according to the settled medical protocol. Therefore, we do not see any element of medical negligence or lack of deficiency in service. In support of this plea, counsel for the complainant has relied upon certain judgments 2009(3) Criminal Court Cases 0461 "Nizam Institute of Medical Sciences versus Prasanth S. Dhananka & Ors." wherein it was observed that complainant is to prove prima-facie case of medical negligence and thereafter, onus shifts upon the hospital or to the attending doctors to satisfy the Court that there was no lack of care or diligence. So far as "Nizam Institute of Medical Sciences versus Prasanth S. Dhananka & Ors." (supra) is concerned, firstly it is the duty of the complainant to establish prima-facie case of medical negligence only then the onus Consumer Complaint No. 37 of 2012 22 will shifts upon the hospital to satisfy the Court that there was no lack or care or diligence but as per our above findings, prima-facie complainant has not been able to prove any lack or care or diligence on the part of Op No. 1. Otherwise, how the medical negligence is to be established. Apart from the evidence discussed above, at the instance of complainant, the Medical Board of Doctors were constituted to check it whether there was any medical negligence or lack of diligence on the part of Doctors. There is a report received from Director, Health and Family Welfare, Punjab bearing memo No. Medical(12)-P-2014/10598 dated 27.11.14 (Ex. Op-1/6). As per directions of Director, Health and Family Welfare, District Family Welfare Officer, Sangrur was appointed as Inquiry Officer alongwith Dr. Rahul, Medical Specialists, Civil Hospital, Sangrur, Dr. Kirandeep Kaur, Gynaecologist and Dr. Poonamdhir, Surgeon, Civil Hospital, Sangrur and they in their report have stated that patient Navjeet Kaur was suffering from AFLP with twin pregnancy in hepatic encephalopathy diagnose and this disease was treated according to HE-Regimen and there was no deficiency or negligence on the part of any Doctor to give the treatment. Therefore, apart from the evidence on the record referred above, there is expert opinion of Board of Doctors consisting of various Medical Officers and they examined the record and also give opportunity of cross-examination to the complainant and his counsel cross examined in length Op No. 1 and other relevant record and ultimately came to the conclusion that there was no negligence on the part of Op No. 1. Against this evidence, no expert opinion or evidence of any other Doctor has come on the Consumer Complaint No. 37 of 2012 23 record that the line of treatment adopted by Op No. 1 was not according to medical protocol or there was any element of negligence on the part of Op No. 1. The basic judgment on medical negligence is "Bolam v Friern Hospital Management Committee", (1957) 2 ALL ELR 118, which was accepted by the Hon'ble Supreme Court as laying down correct tests in cases of medical negligence, in which it was observed that negligence in law means failure to do some act which a reasonable man in the circumstances would do, or the doing of some act which a reasonable man in the circumstances would not do. It was further held that Doctor is not guilty of negligence if he acted in accordance with practice accepted as proper by responsible body of medical man skill in a particular art." He has relied upon the judgment of the Hon'ble Supreme Court "Kusum Sharma & Others versus Batra Hospital & Medical Research Centre & Others", 2010 (3) SCC 480 that 'in case the Doctors have attended the patient with utmost care, caution and skills and with devotion and dedication then the Doctor, who performed the operation had reasonable decree of skill and knowledge and adopted the procedure which in their opinion was in the best interest of the patient then the Doctor cannot be held responsible for negligence.' It was also observed that 'mere deviation from normal professional practice is not necessarily evidence of negligence - Higher the acuteness in emergency and higher the complication, more are the chances of error of judgment - Doctors in complicated cases take chance even if the rate of survival is low. - To prosecute a medical professional for negligence under criminal law it must be shown that the accused did something or Consumer Complaint No. 37 of 2012 24 failed to do something which in the given facts and circumstances no medical professional in his ordinary senses and prudence would have done or failed to do. - The negligence must be culpable or gross and not the negligence merely based upon an error of judgment; medical professional is expected to bring a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged in the light of the particular circumstances of each case is what the law requires. - A medical practitioner would be liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field and that Medical professional are entitled to get protection so long as they perform their duties with reasonable skill and competence and in the interest of the patients. The interest and welfare of the patients have to be paramount for the medical professionals.'
14. Another Medical Board of Doctors was constituted by Board of Civil Surgeon, Ludhiana, which was headed by District Family Welfare Officer, Ludhiana consisting of Dr. Gurmeet Singh, M.D., Med., Dr. Tarsinder Goyal, (M.D. Anaesth) and Dr. Neelam, Gynaecologist and the Board of Doctors in their opinion held that patient suffered from acute fatty liver of pregnancy, which is very serious and fatal illness with very poor prognosis, which occurred spontaneously in this patient, which was bearing twins, which ultimately lead to death of the patient. In nutshell, on the basis of averments made in the complaint and evidence brought on the record, the complainant has not been able to prove on the record any Consumer Complaint No. 37 of 2012 25 case of medical negligence/deficiency in service on the part of Op No. 1.
15. The complainant has also alleged the case of the medical negligence and deficiency in service on the part of Op Nos. 2 & 3. In case we go through the background of the case, when the patient was referred to Op Nos. 2 & 3, on 7.7.2011, the patient was checked by Op No. 1 and on the basis of clinical tests, it was found that patient was diagnosed as AFLP and seeing the critical condition of the patient, she was referred to tertiary hospital i.e. CMC Hospital, Ludhiana and patient was taken to that hospital on the same day and on 9.7.2011, twin babies were delivered by the patient by way of LSCS. Op No. 1 had referred the patient to Dr. K.K. Awasthi, who was Head of Gynaecological Department and allegations of the complainant are the patient was not checked by her but the patient was checked by junior doctors i.e. Dr. Reema Sarkar and Op No. 2 was giving instructions to the junior Doctors on her Cell phone and shifted to the medical ward under Dr. Navjeet Singh Op No. 3 for treatment of Coagulopathy and other related problem whereas patient started labour pain on 8.7.2011 and she was shifted to labour room and they waited for spontaneous delivery for 30-31 hours from starting of the pains and usually Obstetrician wait for 24 hours for normal delivery. In case there is early diagnose, specialists care and delivery of the fatal had led to fall in maternal and prenatal mortality to 1% to 7%, respectively as per Davidson's Principals and Practice of Medicine under the heading, 'Management'. Even LSCS was not performed by Dr. K.K. Awasthi and it was delegated to her junior Dr. Consumer Complaint No. 37 of 2012 26 Shiny Varghese. 3-4 hours were wasted in preparation of LSCS. Further during LSCS drain was put only in the abdominal wall. The patient was in a critical condition and special attention was required but Op Nos. 2 & 3 and their Team treated her as a ordinary case. The drain was removed on 11.7.2011. Then bleeding had collected in the abdomen and on 15.7.2011 laparotomy had to be done, therefore, Ops were negligent in removing drain. Even no arrangement for liver transplantation nor it was suggested by Ops to the complainant. In support of his pleas, he has relied upon the judgment III(2002) CPJ 266 "Dr. Sunil Rungta versus Dr. Chandrashekhar Agarwal" of Jharkhand State Consumer Disputes Redressal Commission, Ranchi. In that case, patient remained in ICU whole of the night. Instructions were issued to juniors. Samples of blood and urine was not collected by Pathology Section. It was held that it was a case of medical negligence. Reference was made to 2015(3) RCR (Civil) 410 "Post Graduate Institute of Medical Education and Research and Ors. versus Amit Sarkar and others". In that case, left leg of girl aged 16 years crushed in Bus accident. She was shifted to PGI. Operation was not performed for two days. The patient developed gangrene and septicaemia. Her leg was amputated and she died after 6 days. It was held that it was a case of medical negligence. Another judgment relied upon is I (2010) CPJ 176 (NC) "Dinesh Jaiswal (Deceased) through L.Rs. & Ors. versus Bombay Hospital and Medical Research Centre & Anr." In that case, Op doctor delegated responsibility to inexperienced junior doctors, which necessitated second surgery. Abnormal delay in surgery resulted in damages to Consumer Complaint No. 37 of 2012 27 muscles of lower limbs due to lack of blood supply. Op Doctor neither visited patient nor gave necessary advice for amputation of legs, which deteriorated the condition of legs. Orthopaedic surgeon opined that if legs not amputated, patient would not survive but after amputation of legs, patient expired. Doctor was negligent. Another judgment referred is I (2008) CPJ 50 (NC) "M. Aiyappan (Dr.) & Ors. versus Lakshmi". In that case, stones were removed by surgery. Health not improved. Complainant developed obstructive jaundice. No proper treatment for obstructive jaundice was given. No proactive steps were taken to do the surgery. It was held as a case of medical negligence.
16. Whereas on the other hand, counsel for Op Nos. 2 & 3 has argued that on admission of the patient to CMC and Hospital, Ludhiana on 7.7.2011, after recording the previous history of the patient and in view of hepatitis and hepatic encephalopathy, she was admitted under the medicines team after checked by gynaecology team in causality. Ultrasound examination showed twin pregnancy. Blood and gestation revealed that she had raised white cell count(leucocytosis), deranged bleeding parameters (coagulopathy) with deranged kidney and liver function. She was given necessary medicine by the team of Doctors of Medicine Department and on 8.7.2011, patient started labour pains and patient was shifted to labour room for further monitoring and expert management by gynaecology team. She was tried for spontaneous vaginal delivery because of (a) First Twins Cephalic Presentation (b) deranged coagulation parameters. She was augmented after four hours but she Consumer Complaint No. 37 of 2012 28 did not progress in the labour. On 9.7.2011, she was taken up for emergency caesarean i.e. LSCS and she delivered twins on 9.7.2011. After surgery, she was shifted to ICU, blood and blood products were given in view of continue Coagulopathy. However, on 12.7.2011, her condition further deteriorated and she required non- invasive ventilation and abdominal distension. Repeat ultrasound done and it showed 1 to 1.5 litre of fluid collection in the abdomen. Therefore, she was taken for laparotomy (surgery) on 15.4.2011 by Gynaecology team after taking high risk consent. Labarotomy was done and 1.2 litre of hemorrhagic peritoneal fluid (blood stained) was removed and a drain was placed in situ (left in abdomen). She was again shifted back to ICU and was put on ventilation support. Patient had hypotension. She was given multi blood and blood products to break up the Blood Pressure. On next day, her urine output dropped. On 17.7.2011, the drain showed some clearing but her renal and hepatic parameters continued to be deranged and her general condition continued to be critical. During haemodialysis on 18.7.2011, her blood pressure further dropped and she died on account of multi organ dysfunction syndrome with acute kidney failure with respiratory, therefore, Op Nos. 2 & 3 alongwith Doctors and other specialists and with the help of available machinery and techniques did their best but could not save life of the patient, therefore, there was no medical negligence or deficiency in service on the part of Op Nos. 2 & 3. On the request of complainant, Medical Board was constituted by the State Government and the District Family Planning Officer, Ludhiana constituted the Board comprising Dr. Gurmeet Singh, M.D., Med., Dr. Consumer Complaint No. 37 of 2012 29 Tarsinder Goyal, (M.D. Anaesth) and Dr. Neelam, Gynaecologist and report is Ex. Op-1/6. Ops were exonerated by the Medical Board and no element of medical negligence or deficiency in service was found by the Expert Board. Against that evidence, no expert or any Doctor was examined by the complainant to say that there was any medical negligence or deficiency in service in giving the treatment to the complainant. Since the patient was a case of AFLP, therefore, on admission with CMC Hospital, Ludhiana (Op-Hospital), she was subject to basic test and she was suffering to various diseases referred above, therefore, she was referred to a Doctor of Medicines for the treatment for those diseases but in the meantime on 8.7.2011, she started labour pains, spontaneous vaginal delivery was waited for but when the labour pains did not go upto the state of delivery then LSCS was the other alternative, which was planned on 9.7.2011 and she delivered twins babies, which are normal and now living a normal life. So far as cause of death is concerned, in the discharge summary she had not died because there was any deficiency in service on account of LSCS or there was any problem in conducting the operation. Operation was successfully performed and after that she died on 18.7.2011 due to multi system failure, although whatever was required, the best was given by Ops. With regard to the urine tube removal after LSCS. There was nothing bad in the operation but some blood had collected in the abdomen due to severe coagulopathy but it was also corrected by way of laparotomy on 15.7.2011. No doubt that LSCS was done under Dr. Shaina Vargese alongwith other team of Doctors. It is clear from the written version Consumer Complaint No. 37 of 2012 30 submitted by the complainant that Dr. K.K. Awasthi was giving directions on her Cell phone to team of Doctors. No doubt that Op No. 1 had referred the case to Dr. K.K. Awasthi, who was head of Gynaecology Department but it is not necessary that every case is to be attended by Dr. K.K. Awasthi. She being Head of Department had team of Doctors and under her supervision, other Doctors had done LSCS. Counsel for the complainant has not been able to point out that Dr. Vargese or other Doctors are not the competent Doctors. It is a tertiary hospital, all facilities are available in the hospital in case of any emergency any specialists can be called for consultation. No deficiency with regard to conducting LSCS has been found except some delay. No doubt that twins were in transverse position but medical literature does not rule out that spontaneous vaginal delivery is not possible, therefore, for certain hours they waited for spontaneous vaginal delivery. As per the arguments raised by the counsel for the complainant they can wait upto 24 hours but they can wait for 30-31 hours. After waiting for 24 hours, some arrangements are to be made for LSCS including the assurance of Doctors of other specialists in case of need and some time is consumed in that process. Ultimately, LSCS was successfully performed and there was no deficiency in performing that LSCS surgery. Nothing bad had happened to the patient on account of some delay in conducting LSCS. For other diseases required medical treatment was given by Op Nos. 2 & 3 and the Hospital. No deficiency in the said treatment has been pointed out by the complainant. In case due to any fatal disease the patient had died, doctors cannot be held responsible as Consumer Complaint No. 37 of 2012 31 no doctor can give 100% guarantee to save the patient. Op Nos. 2 & 3 and the hospital made every effort to save the patient. In case of death, Ops No. 2 & 3 cannot be held liable. Therefore, the complainant has not been able to establish any element of medical negligence or deficiency in service on the part of Op Nos. 2 & 3.
17. How the medical negligence is to be determined has been held by various Courts. The judgments on the points have been referred above. The Doctor is not guilty of negligence if he acted in accordance with practice accepted as proper by responsible body of medical man skill in a particular art." To prosecute a medical professional for negligence under law it must be shown that the accused did something or failed to do something which in the given facts and circumstances no medical professional in his ordinary senses and prudence would have done or failed to do. - The negligence must be culpable or gross and not the negligence merely based upon an error of judgment; medical professional is expected to bring a reasonable degree of skill and knowledge and must exercise a reasonable degree of care.
18. We have considered the contentions as raised by the counsel for the parties. The first point raised by the counsel for the complainant is that when the patient was referred to CMC Hospital, Ludhiana specially to Dr. K.K. Awasthi then Dr. K.K. Awasthi, had not attended the patient personally whereas patient was referred to junior. At the first stage, she was attended by Dr. Reema Sarkar. She was referred to medical unit under the management of Dr. Navjeet Singh as the patient was suffering from various diseases and some Consumer Complaint No. 37 of 2012 32 tests were required to be conducted before going for surgery. On 8.7.2011, the patient started labour pain. She was sent to Labour Room to be monitored by the Gynaecologist team. Pains were augmented after 4 hours but those did not culminate into delivery and on 9.7.2011, LSCS was conducted by Dr. Shaina Vargese and other team of Doctors. No doubt that Op No. 1 had referred to Dr. K.K. Awasthi, who is head of the Gynaecology in CMC. It is not possible for any Head of the Department to attend every case i.e. the reason that she is associated with team of Doctors under her supervision. Dr. Shaina Vargese and team of other Doctors had conducted the LSCS and she was supervising and giving directions to the team as is clear from the written submissions filed by the counsel for the complainant, although the hospital record may not be corroborating it. The core question is whether Dr. Shaina Vargese or other team of doctors were competent to conduct surgery. They are competent Doctors, employed in tertiary hospital. Counsel for the complainant had not challenged their qualification, competency to conduct LSCS and LSCS was successfully conducted. Twins are healthy and were living normal life. The patient/mother had died not on account of LSCS but before her admission with the hospital, she was suffering from AFLP and various other diseases and lateron she died due to multi organ failure, therefore, even if LSCS was conducted by junior doctors, the counsel for the complainant was not able to pin-point any default on the part of team of Doctors in conducting the LSCS. So far as the judgments referred by the counsel for the complainant, those judgments have been delivered keeping in view the facts of those Consumer Complaint No. 37 of 2012 33 cases. In I (2010) CPJ 176 (NC) "Dinesh Jaiswal (Deceased) through L.Rs. & Ors. versus Bombay Hospital and Medical Research Centre & Anr." In that case, junior doctors were inexperience and second surgery had to be conducted. Whereas, counsel for the complainant has not been able to prove case of medical negligence or deficiency in service in case LSCS was conducted by Dr. Shaina Vergest and her team instead of Dr. K.K. Awasthi.
19. The next point raised by the counsel for the complainant is delay in conducting LSCS. His arguments are that patient was having twins pregnancy and babies were in transverse condition and only LSCS was possible and spontaneous delivery was not possible, therefore, immediately, LSCS would have been conducted. According to Reference No. 13 i.e. Textbook of Obstetrics, after caesarean section, indications for caesarean delivery has been referred as under:-
"Caesarean delivery is done when labor is contraindicated (central placenta previa) and/or vaginal delivery is found unsafe for the fetus and/or mother."
and in emergency, the procedure is as under:-
"When the operation is performed due to unforeseen or acute obstetric emergencies. An arbitrary time limit of 30 minutes is thought to be reasonable from the time of decision to the start of the procedure."
No literature has been referred by the counsel for the complainant that in case the position of the twins was transverse spontaneous, vaginal delivery was not possible. When the labour pains did not Consumer Complaint No. 37 of 2012 34 terminate into delivery then LSCS was planned and it was done successfully. According to the version given by the complainant that they should have waited for 24 hours but they waited for 30 hours, therefore, there was delay of 6 hours. Once they waited for 24 hours, some time is taken in the management and planning and consultations with various specialists about their presence in case of emergency. In case LSCS was successfully conducted then delay of some few hours is certainly not a case of medical negligence.
20. Another plea was raised by counsel for the complainant that directly on 7.7.2011 the patient could be referred for LSCS. However, it was not possible because on examination, it was found that she had jaundice, facial puffiness(swelling), asterisis (flapping tremors), bilateral pedal edema(swelling of feet), therefore, she admitted under medicine team and various tests were also conducted in the CMC Hospital, which are part of patient file Ex. Op-2/3, therefore, when the patient for the first time comes to the hospital, hospital conducts their pre-operative tests, therefore, we do not agree with the plea raised by the counsel for the complainant that seeing the critical condition of the patient, the Doctors would have gone for LSCS on the same day because it is the Doctor, who are to see pros and cons of everything and before pre-operative test, no surgery is possible and then labour pain had started on 8.7.2011. They waited for spontaneous vaginal delivery, when it was not possible then on 9.7.2011, LSCS was conducted. There does not seen any delay in conducting the delivery.
Consumer Complaint No. 37 of 2012 35
21. With regard to removal of drain on 11.7.2011, the drain was put after the LSCS that in case any fluid is collected in the abdomen then that fluid should be removed by way of drain. As on 11.7.2011, they did not see any soak flow of fluid, therefore, it was removed and lateron due to coagulopathy, some blood had collected in the abdomen and by way of laparotomy, it was removed. Therefore, removal of drain was not a material aspect, which lead to the death of the patient. Since the patient was suffering from various diseases as referred above, every effort was made by team of Doctors to save the patient but it is not necessary that Doctors are 100% successful. It is to be seen whether the Doctors had adopted appropriate line of treatment. During the course of arguments, counsel for the complainant was unable to pin-point any deficiency with regard to the treatment given after LSCS or what other procedure should have been adopted by the Doctors, but in case they were unable to save the patient, it does not mean that the Doctors were negligent in performing their duties. No doubt that the complainant was upset with the death of his wife and everybody will be upset in such circumstances and it comes in the mind of every right thinking person that the Doctors may not have given appropriate treatment leading to the death of the patient, therefore, they moved an application before Civil Surgeon, Ludhiana to set up a team of Doctors to give the opinion whether there was any negligence on the part of treating Doctor. The Board of Doctors was constituted under the team consisting of Dr. Gurmeet Singh, M.D., Med., Dr. Tarsinder Goyal, (M.D. Anaesth) and Dr. Neelam, Gynaecologist and the Board Consumer Complaint No. 37 of 2012 36 of Doctors in their opinion held that patient suffered from acute fatty liver of pregnancy, which is very serious and fatal illness with very poor prognosis, which occurred spontaneously in this patient, which ultimately lead to death of the patient.
22. The complainant in rebuttal to the report of Board has not produced on the record any other report or has not examined any Doctor to say how Op Nos. 2 & 3 were negligent in performing their duties. Simply because the patient had died, we cannot say that the Doctors are medically negligent or deficient in their service. If the procedure has been correctly followed then Doctor cannot give 100% success and a reference has been made to "Martin F. D'Souza versus Mohd. Ishfaq" 2009(1) CPC 619 wherein it has been observed that Doctor cannot be held liable for medical negligence simply because the things went wrong due to error of judgment. He can be made liable if his/her conduct fell below the standard required to be adopted by a competent medical professional in the treatment of a patient.
23. In case we collectively examined the allegations made by the complainant in his complaint and reply filed by Ops, evidence and documents on the record, expert reports and medical literature referred on the record and detailed discussion referred above, we are of the opinion that the complainant is not successful to prove on the record that Ops were medically negligent in treating the patient Navjeet Kaur or that there was any deficiency in their service. Therefore, we are of the opinion that complaint filed by the Consumer Complaint No. 37 of 2012 37 complainant is without merit, it is hereby dismissed. No order as to costs.
24. The arguments in this Consumer Complaint were heard on 5.4.2016 and the order was reserved. Now the order be communicated to the parties as per rules.
25. The Consumer Complaint could not be decided within the statutory period due to heavy pendency of Court cases.
(Gurcharan Singh Saran)
Presiding Judicial Member
April 20, 2016. (Jasbir Singh Gill)
as Member
Consumer Complaint No. 37 of 2012 38