- (1.) THIS complaint has been filed under Section 17 of Consumer Protection Act, 1986 seeking direction for payment of compensation of Rs. 40,00,000 along with interest @ 18% p. a. on account of negligence committed in treatment of wife of complainant No.l, against the OPs and also compensation of Rs. 5,00,000 for mental agony and loss of consortium and love and affection of mother to complainant No.2.
(2.) IT is not in dispute that wife of complainant No.1 Smt. Priya Sharma was pregnant and visited clinic of OP No.1 for management of her pregnancy. OP No.1 is a Gynaecologist and is proprietor of OP No.2/ Nursing Home. The lady was under supervision of OP No. 1 and she contacted regularly her Nursing Home for checkup. She went thrice in the month of November, 2003, once in the month of December, 2003, January, February, March and April, 2004 and twice in the month of May, 2004. Her expected date of delivery was also told. Every time when she contacted the Nursing Home, then regular checkup was done including blood test, test of blood pressure and sonography for the purpose of determining the state of foetus. In the month of June; 2004 on 5th she went to Nursing Home at 5:30 a.m. in the morning, when she started having labour pain. After checkup it was informed by OP No.1 to the patient and the attendants that on account of some complications caesarean operation will be required. Consent was given by the patient as well as the attendants and then on the same day, in the morning the lady delivered a.female baby by caesarean operation and was shifted to another room. After sometime she started bleeding which could not be controlled by medicines. Blood was arranged and was transfused to the lady. But ultimately it was found that on account of certain complications removal of uterus would be necessary. Then second operation was performed and uterus was removed by emergency hysterectomy. Dr. Sandeep Dave, Surgeon along with OP No.1 conducted the operation. The case of the complainant is that Mrs. Priya Sharma was continuously consulting the Nursing Home of OP No. 1 and was under continuous supervision of OP No.1. She went to her as and when called for regular checkup and paid fees every time. The expected date of delivery was told by OP No.1 as first week of June, 2004, but when labour pain started on 5.6.04, then she reached the hospital and got herself admitted. OP No. 1 after checkup first told that there will be normal delivery, but later on it was informed that the foetus is somewhat heavy and has turned in opposite direction and therefore operation would be necessary on getting this information, consent was given and operation was performed, but after sometime it was found that condition of Mrs. Priya Sharma was deteriorating. She vomited and was consistently having bleeding. When OP No.1 was called then she told that there is no reason to worry and these are normal features of delivery. Later on, on her direction two bottles of blood were arranged and blood was transfused to Mrs. Priya Sharma. But, even then loss of blood was continuing and then OP No.1 informed the complainant No.1 that for saving life of Mrs. Priya Sharma, it is necessary to perform operation of hysterectomy for removal of uterus. The complainant No. 1 was having no other option but to agree with the suggestion and so gave consent. Then, at about 3.30 p.m. in the Nursing Home of OP No. 1, Dr. Sandeep Dave was called and then operation was performed. This operation was also performed under supervision of OP No.1, but even after that operation, the condition of Mrs. Priya Sharma remained very poor. On next day, it was found that there was no urinary output and then Dr. Shubha Dubey, Nephrolo -gist, was called, when complainant No.1 asked then no satisfactory reason was given. When urine had not passed even after administering injection and medicines, then also the OP No.1 stated that there is nothing to worry and everything will be alright very soon. The complainant No.1 was advised to deposit Rs. 10,000 more and later on, on the same day, when urine had not passed then OP No.1 said to complainant No.1 that Dr. Shubha Dubey, be immediately contacted because the case has become complicated and OP No.1 is unable to understand the reason of complication. She also said that she has now become helpless and the case has gone from her hands. She advised to contact Dr. Shubha Dubey and Dr. Sandeep Dave. Then immediately Dr. Shubha Dubey was contacted, who informed that condition of Mrs. Priya Sharma is very poor and there are feeble chances of her survival. She would be required to put on dialysis. Then, Mrs. Priya Sharma was admitted in the Nursing Home of Dr. Shubha Dubey. OP No.1 herself accompanied her up to the Nursing Home of Dr. Dubey. Dr. Shubha Dubey again performed certain tests and sonography and after examination informed that still the bleeding was continuing in the abdomen and had clotted there and in such condition dialysis was not possible. She informed that the patient is required to be shifted to some big Medical Center. It was also informed by her that on account of excessive bleeding the kidney of the lady had affected adversely and had stopped functioning because no blood was supplied within reasonable time, from the time of bleeding. Then, the patient was shifted to MMI Hospital on the same day i.e. 7.6.04 in the night and remained there under treatment. There also it was informed that there was insufficient blood transfusion, which resulted in loss of blood pressure and kidney failure. In that hospital, the patient was put on dialysis machine, three times, but ultimately on 15.6.04, she died. It is alleged in the complaint that Mrs. Priya Sharma died on account of negligence of OP No.1, in her treatment and caesarean operation was unnecessary, even then it was performed. Sufficient blood was not supplied to her after excessive bleeding. It was never informed to complainant No.1 that Dr. Sandeep Dave has been called. When kidney of the patient failed urinary output and further operation of hysterectomy was performed, even then nothing was informed to the husband of the patient. Treatment papers were also not provided to husband of the patient. It has also been alleged that as per post -mortem report, the intestine became adherent to each other and it is possible that during operation there was a cut to the intestine and that is why they have became adherent. On the basis of above allegations, it has been prayed that on account of medical negligence committed by OP No.1, Mrs. Priya Sharma died and so the complainants are entitled to get compensation of Rs.40,00,000 on account of death of Mrs. Priya Sharma and Rs.5,00,000 as compensation for deficiency in service, unfair trade practice and loss of love and affection to the newly born baby.
(3.) OP No.1 in reply has denied the allegations leveled by complainants in the complaint. It has been specifically pleaded that after 9.5.04, Mrs. Priya Sharma had not come for regular checkup, though she was instructed orally and pamphlet was also supplied, that in the last month of pregnancy, weekly checkup is necessary, but after 9.5.04, she only came to OP No.1 on 5.6.04, at 5.30 a.m., when there was leakage of amniotic fluid due to Premature Rupture of Membranes (PROM), which was abnormal beginning of labour. The investigations which were necessary and were due in the last month of pregnancy could not be carried out, on account of her not attending the hospital of the OP No.1. It has also been averred that expected date of delivery was 3.6.04 and was informed to the lady, but even on that date she failed to come and she came two days later from that date and after a gap of about 26 days from the date of last attending the Nursing Home, so it was a post -dated case. When the lady was examined on 5.6.04, in the morning, then it was found that PROM had already taken place with leaking of amniotic fluid with Cx only 2 fingers dilated and there was Cephalo -Pelvic Disproportion (CPD). An emergency portable ultrasonographic screening was done, in which the position of the baby was seen to be cephalic (head down position), but there was umbilical cord round the neck, which too was a dangerous feature for the baby. Still more important fact, found on examination was that there was remarkable edema(+++) (generalized swelling) of her body, the blood pressure was high with 160/106 mm Hg and her urine contained albumen (++). These three cardinal features confirmed that she was suffering from pre -eclampsia, i.e. Toxemia of Pregnancy, a.serious illness that usually appears in the last month of pregnancy. In presence of pre -eclampsia along with other indications, the labour should not have been allowed to progress in its natural course and baby should be delivered without delay by caesarean section for the safety of both the mother and the baby. Any of the complications, i.e. CPD, PROM and cord round the neck, would have definitely caused life -threatening problems to both, the mother and the baby, therefore immediate caesarean section was necessary and was done. She gave birth to a female baby and the baby and the mother both were alright and were shifted to a ward. She vomited once, but this was a side effect of injection Prostadin. She started bleeding per vagina, initially within normal limit. A monitor was showing her pulse, blood pressure, SP02 for Oxygen saturation, ECG recordings etc. was attached to her and constant watch was kept also on the bleeding, fluid intake and urine output. At 9.30 a.m. when the bleeding was first noted, she was immediately given injection Methergin I.M. and intravenous drip of Oxytocin in 5% dextrose solution to stop bleeding. But in spite of that, the bleeding was found to be increased, then again injection was given and drip was continued. Her urine output at this stage was 400 ml, which was a sufficient quantity. The blood pressure was 110/60 at 11.20 a.m. At 11.45 a.m., when blood pressure fell from 110/60 to 100/60, then one bottle of I.V. Haemaccel, a plasma expander, was immediately started to replace the blood loss. I.V. Tranexmic acid given to stop bleeding and injection Prostadin was repeated and advice for emergency blood transfusion was given. At 12.00 noon it was found that the bleeding had become less. Her condition became stable, the pulse and blood pressure were normal. Blood transfusion was started as soon as blood was received from the blood bank. When there was re -bleeumg at 1.15 p.m., then it was decided that emergency hysterectomy operation for removal of uterus will be necessary. The situation was discussed with the relatives of the patient and inevitability to remove the uterus to save life if the lady was explained. Consent was obtained and simultaneously she consulted Dr. Sandeep Dave, M.S. a noted surgeon of Raipur. Dr. Ashok Sonker, Anaesthetist was called and them Mrs. Priya Sharma was shifted to the Operation Theater. Blood transfusion along with other medicines was continued. Before shifting to Operation Theater, one bottle was already given and the second one started, and the blood pressure was kept normal. When Dr. Dave arrived, prior to that it was found by OP No. 1 on examination that the uterus was not contracting, which is a serious condition called Atonia of uterus. The condition was discussed with the husband of the patient by OP No. 1 as well as Dr. Sandeep Dave, It was explained that atonia of uterus and the resultant intractable bleeding show that no other remedy was left than to remove the uterus to save her life. Again consent was obtained from husband of the patient in presence of two witnesses, mentioning that he has been informed that she could not conceive again the operation of hysterectomy was performed. She was kept in ICU, the uterus which was removed, was found flabby like a loose bag, which did not contract in spite of every possible measure. This unusual condition of atonia of uterus is associated with severe bleeding. The relatives of the patient were called inside the Operation Theater by taking unusual decision and then flabby uterus was demonstrated to them. The complainant No.1, his brother, an uncle and one lady have all seen the uterus. After removal of uterus, there was complete stoppage of bleeding, and the abdomen was closed in layers as per principles of surgery. The uterus was sent for histo -pathological examination to Dr. Chhaya Rathi, who conducted that examination and made diagnosis of this condition as Placenta Accreta, which means that the placenta was abnormally adherent to the wall of uterus, which was the cause of atonia and the severe bleeding. Thus, the action of OP No. 1 was to save life of the patient Mrs. Priya Sharma, looking to her condition and after operation, her condition became stable. Bleeding was stopped and there was no further deterioration in her condition. Her pulse and blood pressure were stabilized. But she was still a case of pre -eciampsia and in spite of treatment its effect would pass off gradually. When urine output had decreased, as observed by Dr. Sonker and OP No.1, then in order to treat this in the initial stage, the OP No. 1 called a senior physician Dr. Rajesh Gupta, MD for advice, who came to the OP and prescribed injection Dytor and Lasix, which was given to the lady for increasing urine output, but even then urine output did not improve, then Dr. Shubha Dubey, Nephrologist was called in the morning and she diagnosed the case as ARF (Acute Renal Failure) and suggested for dialysis. Complainant No.1 also met Dr. Shubha Dubey and then OP No.1 herself along with Dr. Ashok Sonkar, Anaesthetist and Dr. S.N. Madharia, husband of OP No.1, took the patient to Dr. Shubha Dubey's hospital where condition of the patient was discussed and from there, on the advice of Dr. Shubha Dubey, the lady was shifted to MM1 Hospital. It has been totally denied by OP No. 1 in the written version that on account of negligence of the treating doctor and surgeon, condition of the patient deteriorated and she died. On the contrary it has been alleged that it was a case of pre -eclampsia, which developed in the last month of pregnancy and could not be detected as the patient had not contacted the doctor during that period. There was toxemia of pregnancy which affected the kidney as well as other organs of the patient and became cause of death. The OPs have totally denied the allegation of medical negligence. We have heard arguments of both parties and perused the record of the case.;