State Consumer Disputes Redressal Commission
Dr. Ramalingam, M.D., D.G.O., vs Rapolu Kode Nageswara Rao, And Others on 29 July, 2013
BEFORE THE CIRCUIT BENCH A.P STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT VIJAYAWADA F.A.No.865 OF 2011 AGAINST C.C.No.292 OF 2010 DISTRICT FORUM GUNTUR Between Dr. Ramalingam, M.D., D.G.O., s/O Satyanarayana, Aged 49 years, R/o Unit Chief, Associate Professor, NRI General Hospital, China Kakani post, Mangalagiri Mandal, Guntur District. Appellant/ opposite partyno.2 A N D 1. Rapolu Kode Nageswara Rao, S/o Yadagii,R/o Kothareddypalem, Chebrole Mandal,Guntur District. Respondent/Complainant. 2. Dr. Butchi Babu, M.D., Superintendent, 3. Dr. P. Hymavathi, OBG & GYN., Head of the Department, 4. K. Anji Reddy, All are R/o NRI General Hospital, , China Kakani post Mangalagiri Mandal, Guntur District. Respondents/ opposite parties no.1, 3 and 4 Counsel for the Appellant M/s V.V.Anil Kumar Counsel for the Respondent M/s Durga Prasad (R1) Served (R2&4) Held sufficient (R3) QUORUM: SRI R.LAKSHMINARSIMHA RAO, HONBLE MEMBER
& SRI THOTA ASHOK KUMAR, HONBLE MEMBER MONDAY THE TWENTY NINETH DAY OF JULY TWO THOUSAND THIRTEEN Oral Order ( As per R.Lakshminarsimha Rao, Member) ***
1. The opposite party no.2 is the appellant. The appeal is challenge to the order of the District Forum whereby the appellant is directed to pay a sum of `3 lakh with interest thereon to the respondent no.1. The respondent no.1 filed complaint claiming a sum of `10 lakhs towards compensation on account of death of his wife and he claimed the amount on the premise of deficiency in service on the part of the appellant.
2. The case of the first respondent as seen from the averments of the complaint is that his wife Rapolu Sailaja was pregnant and used to visit the hospital of the appellant during her pregnancy period. The appellant and the respondent no.2 informed the first respondent that his wife was in a fit condition for safe delivery. On completion of nine months and when the first respondents wife developed labour pain, she was admitted in the hospital of the appellant at 4.20 p.m. on 13.6.2008 and she delivered a female child the next day i.e., 14.6.2008. The appellant and the respondent no.2 informed the respondent no.1 that his wife died at 5.30 a.m. on 14.6.2008 due to hypotension and cardiac arrest as a result of PPH. The doctors at the hospital of the appellant subsequent to the death of first respondents wife advised him for purchase of medicine worth `1,360/-
and blood worth `1,000/-. The first respondents wife died due to negligence of nursing staff and the doctors of the hospital.
3. The second respondent resisted the claim contending that the third respondent is in-charge of the first unit patient and there was no occasion for her to examine or treat the first respondents wife. The first respondent wife was admitted in 3rd unit and the working hours of NRI hospital was 9.00 a.m. to 4.00 p.m. The second respondent left the hospital at 4.00 p.m. on 13.6.2008 and the first respondents wife was admitted in the hospital at 4.30 p.m. on 13.6.2008. The delivery was conducted by the duty doctor of unit no.3. The patient delivered normally in the labour room. In the early hours of 14.6.2008 the patient developed bleeding and the appellant attended on her and she died in the early hours of 14.6.2008. The second respondent is an administrative head and retired on 30.4.2010 as head of the department and Dr.P.Vasanth Kumar was appointed in the place of the second respondent.
4. The appellant has contended that the first respondents wife was pregnant for third time and the expected date of delivery according to 14 weeks time was 27.6.2008. The patient was not sure of her lost menstrual date. She visited the hospital for the last time on 23.4.2008 and she failed to pay visits during later stages of her pregnancy. She came to the hospital on 13.6.2008. She visited other private hospitals where she was advised for caesarean section. The first respondents wife was shifted to labour room at 6.30 p.m. on 13.6.2008 and Dr.Vasanth Rao, DGO attended the patient. She gave birth to a female baby through normal vaginal delivery at 00.44 hours on 14.6.2008. After delivery bleeding was within normal limits. Suturing of episiotomy wound was done and she was shifted to observation ward at 1.30 a.m.
5. She was permitted to have an attendant. At 2 a.m. her vitals were stable and bleeding was within normal limits. At 2.15 a.m. her attendant informed the duty doctor that she complained of weakness and pain in her abdomen. She was conscious, coherent and very pale. Her pulse rate was 120 p.m. and BP 80/60 hg. Uterus was relaxed. Her underclothes and bed sheet were soaked with blood. Clots of blood were removed from vagina of the patient. There was total loss of 1500 to 2000 ml blood. IV fluids and injections were administered to stop further bleeding. Blood was arranged for transfusion.
6. The patient had subsequent bout of bleeding at 2.50 a.m. due to relaxation of uterus. Her vitals were deteriorating, heart rate was increasing, BP was falling and oxygen saturation was decreasing. AT 3.00 a.m. Dr.Laxmi Narayana examined the patient. Her vitals were not improved. Dopamine was administered to improve BP as also hydrocortisone was given. At 4.15 a.m. the patient had not responded to commands. Bleeding was subsided and her condition was informed to the anaesthetist for artificial respiration. Intubation was done. The patient was died at 5.30 a.m. due to irreversible shock due to PPH. The doctors were cautious, alert and dutiful. The first respondent did not report any negligence during the treatment period. The complaint is not maintainable without impleading the authorities of the hospital.
7. The first respondent filed his affidavit and the documents, Exs.A1 to A5. Ex.X1 is marked on behalf of the first respondent. On behalf of the appellant and the respondents no.2 to 4 Ex.B1 was marked.
8. The District Forum allowed the complaint on the premise that the appellant and the respondents no.2 to 4 failed to transfuse blood at the time drugs were administered to the patient and loss of time in transfusing blood aggravated the condition of the patient and that the appellant did not act diligently.
9. Aggrieved by the order of the District Forum the second opposite party has filed appeal contending that the District Forum observed that the deceased was negligent as also the first respondent and yet the District Forum proceeded to award a sum of Rs.3 lakh towards compensation. It si contended that the first respondent has not impleaded the hospital authorities as party to the proceedings and that the enquiry report issued by the expert committee found the treatment rendered by the appellant proper.
10. The point for consideration is whether the order of the District Forum suffers from misappreciation of facts or law?
11. There need be no discussion on the facts admitted by the appellant, the respondent sno.2 to 4 and the respondent no.1.
Following facts considered to be admitted are mentioned by the District Forum in para 7 of the order.
1. Smt Sailaja Rapolu (Wife of the complainant) wad admitted in NRI General Hospital for delivery.
2. The said Sailaja gave berth to a female baby under normal delivery on 14 -6-08 at about 0.44 am.
3. The said Sailaja after delivery developed bleeding.
4. The said Sailaja breathed her lost at about 5.30 am on 14 -6-08.
5. Mother of the said Sailaja was present at the time of delivery.
6. Exchange of notices between the complainant and the opposite parties 1 to 4 (Exs.
A-2, A-4 amd A-5).
7. NRI General Hospital maintained case sheet Ex.A-1 (=B-1)
12. The first respondent has attributed negligence to the respondents no.2 to 4 on the premise that they failed to act in proper manner and exercise skill in rendering treatment to his wife. In regard to the non-impleadment of the hospital, the District Forum held that the complainant cannot be dismissed on the ground that hospital is not made party to the complaint though the doctor is found deficient in rendering service.
13. The medical board expressed its opinion as to whether the appellant and the respondents no.2 to 4 were negligent in rendering treatment to the patient. The doctors of the expert committee had in unequivocal terms had expressed their opinion that the appellant and the respondents no.2 to 4 failed to exercise due care and seriousness of the health condition of the patient was not informed to her or her relatives as also they had not arranged for blood in proper time. The opinion given reads as under:
Impression: We the Enquiry Committee after thoroughly studying the case sheet of the opinion Seriousness of the health of the pregnant woman was not informed to the patient relatives at the time of admission. Risk was not assessed properly. Not arranged blood in proper time.
14. There is no contra evidence to the opinion of the expert committee that blood was not arranged in time which have contributed to the case of death of the patient.
15. The manner in which a doctor has to attend for prophylactic management is referred to by the author in the management of postpartum haemorrhage. The relevant paras of the article are extracted hereinbelow:
On admission in labour, a full blood count should be done and blood cross matched. It is preferable to have an intravenous line with a wide bore cannula (16 or 18G) prior to the second stage of labour. The third stage should be managed actively, administering 0.5 mg of ergometrine intravenously with the delivery of the anterior shoulder of the baby. In patients with hypertension and cardiac disease, ten units of intravenous syntocinon should be given instead of ergometrine.
Some woman as well as some physicians have challenged active management of the third stage of labour (Chamberlain 1985; Milton 1985; Dunn 1985). The meta-analysis of controlled trials shows that the routine use of oxytocics in the third stage of labour reduces the risk of PPH by about 30-40%.
The general condition of the patient, the amount of blood loss and the degree of hypovolemia should first be assessed quickly. At the same time blood should be sent for full blood count and cross matching with request for four to six units of blood. Preferably two intravenous (IV) lines with a 16 or 18 gauge cannula should be set up. Crystalloids or colloids should be given, depending on the condition of the patient. When the patient has hypotension and is not shocked, two litres of crystalloids can be given in 1-2 hrs and if there is no response or if the condition deteriorates, colloids, plasma or blood should be given immediately. If the patient is in shock she should be resuscitated. The second IV line with a 16 gauge cannula should be set up if it was not started earlier and colloids, plasma or blood started immediately. As uterine atony is the cause of PPH in about 80% of instances, the uterus should be massaged continuously to induce contractions and to assess whether it is contracting. Massaging should be done properly so that the uterine muscle is massaged and not the abdominal wall, and it should not be so vigorous as to cause severe pain to the patient or a broad ligament hematoma. The vital parameters such as the level of consciousness, pulse rate, blood pressure intake/output, level of the uterine fundus and the amount of blood loss should be monitored carefully.
16. The appellant failed to discharge burden of proof cast on him in showing that he and the respondent no.2 had exercise due diligence in making arrangement of blood for transfusion to the patient in time. The District forum has discussed importance of time and its impact on delayed transfusion of blood to the patient as under:
19. The para wise remarks for the impression mentioned in Ex-X1 by the opposite parties 1, 2 and 4 in the context of the patient losing blood of about 1500 ml after delivery in our considered opinion did not hold good. While administering drugs for controlling bleeding it could have been better if blood was also transfused at the same time. The loss of time in transfusing blood in our considered opinion might have aggravated the condition of the patient. For the above discussion we hold that the 2nd opposite party did not act diligently as observed by the expert committee in Ex.X-1 report.
We therefore hold the 2nd opposite party committed deficiency of service. For the discussion made supra we answer this point accordingly.
17. For the foregoing reasons we do not find any infirmity in the findings recorded by the District Forum and as such the appeal is liable to be dismissed.
18. In the result the appeal is dismissed confirming the order of the District Forum. There shall be no separate order as to costs.
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