- (1.) The petitioners, the husband and wife, have moved this petition under Article 32 of the Constitution with manifold prayers. In the course of hearing, Mr. Colin Gonsalves, learned senior counsel appearing for the petitioners, has restricted his argument to prayer (g) which pertains to issue of direction for constituting a medical board to assess the pregnancy of the 1st petitioner and direct for termination of the pregnancy.
(2.) When the matter was listed on 21.6.2017, the Court took note of the prayer for appointment of a panel of doctors at a Government hospital in Kolkata to examine the state of health of the mother and accordingly directed the matter to be listed on 23.6.2017. When the matter was listed on 23.6.2017, this Court had passed the following order :- In pursuance of the previous order of this Court "dated 21.06.2017, learned standing counsel appearing on behalf of the State of West Bengal has placed on the record his instructions indicating that a team of senior Doctors may be constituted to evaluate the mental and physical health of the first petitioner and the state of health of the foetus. At this stage, the pregnancy is in its 25th week. The court has been apprised of the medical reports produced on record by the petitioners, including the opinion of Doctor Devi Shetty, which is annexed to the paper book. We accordingly constitute a Medical Board consisting of the following Doctors to examine the first petitioner and her foetus at the Institute of Post Graduate Medical Education and Research (SSKM Hospital) situated at 244 A.J.C. Bose Road, Kolkata -700 020: NAME HOSPITAL ATTACHED Prof.(Dr.) Arati Biswas National Medical College and Hospital Prof (Dr.) Suchandra Mukherjee I.P.G.M.E.R. (SSKM Hospital) Prof (Dr.) Utpal Das I.P.G.M.E.R. (SSKM Hospital) Prof (Dr.) Subhas Chandra Biswas I.P.G.M.E.R. (SSKM Hospital) Prof (Dr.) Acchyut Sarkar I.P.G.M.E.R. (SSKM Hospital) Prof (Dr.) Sujitesh Saha I.P.G.M.E.R. (SSKM Hospital) Prof (Dr.) Santanu Datta I.P.G.M.E.R. (SSKM Hospital) We request the Medical Board to examine the first petitioner and to submit its evaluation report of the first petitioner and the foetus to this court on 29.06.2017 in a sealed cover. A copy shall also be furnished to the Standing counsel for the State of West Bengal in sealed cover. List on 29th June, 2017." In pursuance of the aforesaid order, a Medical Board was constituted and a report was submitted before this Court on 29.6.2017. Thereafter, the matter was directed to be listed today.
(3.) It is submitted by Mr. Colin Gonsalves, learned senior counsel appearing for the petitioners that the medical report clearly stipulates the condition of the 1st petitioner and if the report is appositely appreciated, the direction, as prayed for, deserves to be granted. We think it appropriate to reproduce the observations and opinion of various members of the Medical Board. The report of the Medical Board reads as under :- "Observation of Dr. Utpalendu Das, Professor and H.O.D. of Radiology, IPGMER-SSKM Hospital, Kolkata- As per the available medical records including anomaly scan dated 25/05/2017 at gestational age of 20 weeks 5 days reveals single life intrauterine fetus with normal fetal anatomy and grown except cardiac anomally with suggestion of Tetralogy of Fallot: Fetal Echocardiography done on 6th June, 2017 reveals - Tetralogy of Fallot Large perimembranous VSD with inlet extension (bidirectional flow) Aorta from LV overriding the VSD Pulmonary atresia Duct/MAPCA dependent pulmonary circulation Good Veticular Function Opinion of Dr. Saroj Mondal, Asst. Professor of the Department of Cardiology, IPGMER-SSKM Hospita, Kolkata regarding continuation of pregnancy of Mrs. Sarmistha Chakrabortty, who is carrying 20 weeks 5 days as on 25.05.2017 of pregnancy with normal fetal growth having fetal cardiac malformation detected by fetal echo cardiography on 6th June, 2017 in the form of Tetralogy of Fallot Large perimembranous VSD with inlet extension (bidirectional flow) Aorta from LV overriding the VSD Pulmonary atresia Duct/MAPCA dependent pulmonary circulation Good Veticular Function As the fetus has complex cardiac anomaly and if pregnancy continued mother will need delivery in a highly equipped centre with facility of neonatal cardiac intervention and surgical facility and will need multiple staged cardiac surgical operation and each occasion, it will have high morbidity and mortality risk. This case, I already discussed with Dr. Acchyut Sarkar, Associate Professor of the Department of Cardiology, IPGMER-SSKM Hospital, Kolkata who is appointed as Pediatric Cardiologist of this Medical Board. Impression of Dr. Santanu Dutta, Associate Professor of the Department of C.T.V.S., IPGMER-SS KM Hospital, Kolkata - As per the medical reports available, the fetal echocardiography shows Fetal complex congenital cyanotic heart disease. Impression: Pulmonary Artesia with Hypoplastic PAS, large VSD and collaterals arising from aorta. It is evident from the report that the neonate needs complex cardiac corrective surgery stage by stage after birth. But there is high mortality at every step of this type of staged surgeries. Opinion of Dr. Sujitesh Saha, Associate Professor of the Department of Paed. Surgery, IPGMER-SSKM Hospital, Kolkata As per the medical reports and fetal echo cardiogram done on 6th June, 2017, the fetus is having tetralogy of Fallot, Pulmonary atresia and large VSD, Multiple Collaterals arising from aorta to support the pulmonary circulation. As per records, there is no other fetal congenital malformation detected. On examination fetal growth parameters are normal. After birth multiple staged cardiac corrective surgery will be required which will be associated with high mortality and morbidity at every stage. Opinion of Dr. Suchandra Mukherjee, Professor and HOD of Neonatology, IPGMER-SSKM Hospital, Kolkata Pet the fetal echo-cardigraphy report dated 6th June, 2017, the fetus is having tetralogy of Fallot. Pulmonary atresia and large VSD, Multiple Collaterals arising from aorta to support the pulmonary circulation. No their fetal congenital malformation was demonstrated in the anomalies scan done at 20 weeks of gestation on 25th May 2017 and fetal growth parameter was found to be normal. In view of the cardiac malformation, the baby, after birth will require intensive cardiac monitoring and staged management through the surgical procedures which will have high risk of morbidity and mortality depending upon the postnatal course. Finally in pursuance of the Notice of the Director, IPGMER, Kolkata vide Memo N. Inst./5445 dated 23rd June, 2017, a medical board has been convened at 10.00 am on 27th June, 2017 in the Office Chamber of Dr. S.C. Biswas, Professor of the Department of Gynae and Obst, IPGMER-SSKM Hospital, in presence of all members of the constituted Medical Board by the Hon'ble Supreme Court, India. However, Associate Professor Dr. Acchyut Sarkar, Department of Cardiology was absent. He deputed Dr. Saroj Mondal, instead of him to express the view of Pediatric Cardiologist, IPGMER-SSKM Hospital, Kolkata The patient, 1st Petitioner of the case Mrs. Sarmisth Chakrabortty, 33 years old, w/o Mr. Anirban Chakrabortty was examined by the Board Members and all the members expressed their views. Two Gynaecologists, (1) Professor Subhash Chandra Biswas and (2) Professor Arati Biswas, on good faith examined the patient physically and observed the following findings: Her L.M.P.-27.12.2016 E.D.D.-4.10.2017 and she is G2Po+1+0+0 Previous pregnancy- she had sudden bleeding P/V and pain abdomen at approximately seven and half months and delivered in Appolo Hospital, Kolkata, a still born baby vaginally (as per previous records) in 2015. On examination- She is conscious and co-operative with profound mental agony. Her Vitals-stable Per abdominal examination reveals 1. Fundal height of gravid uterus- 24 weeks+ (approx 26 weeks) (Corresponding to period of amennaorhoea) 2. Liqour-adequate (as per period of gestation) 3. Fetal parts-Palpable 4. F.H.S.+ and Regular Patient, herself spontaneously expressed her wish not to continue this pregnancy in view of the detected fetal cardiac anomalies so far. On reviewing of the available records of the patient i.e. U.S.G., Fetal Echo-Cardiography including the prescription of the attending Obstetrician in Apollo Hospital, Kolkata, the other members of the Board (Radiologist, Cardiologist, Neonatologist, Pediatric Surgeon and Cardiac Surgeon) have opined that "the fetus has been detected to have cardiac malformation in the form of Tetralogy of Fallot, Large perimembranous VSD with inlet extension (bidirectional flow), Aorta from LV overriding the VSD, Pulmonary Atresia, Duct/MAPCA dependent pulmonary circulation and Good Ventricular function. The child, if born alive, need complex cardiac corrective surgery stage by stage after birth. But there is high mortality and borbidity at every step of this staged surgeries". The cardiac anomaly has been confirmed by serial investigations. In view of the above facts and opinion, we, the two Gynaecologists, in good faith like to opine that the patient is at the threat of severe mental injury, if the pregnancy is continued. Therefore, if the patient wants termination of this pregnancy, she may be allowed with prior informed consent of inherent risk of her health for procedural inventions, because there is additional risk of termination of the pregnancy once it is beyond 20 weeks as the present case is. However, this is a special case and conclusion has been drawn on its individual merits." ;