Decided on May 25,2009

MINI Respondents


K.R.UDAYABHANU, J. - (1.)THE appellants are the opposite parties in OP 1020/95 in the file of CDRF, Thrissur. The 1st opposite party is under orders to pay Rs. 16,000 with interest at 6% per annum from the date of application as pecuniary damage and Rs. 50,000 towards general damage for mental harassment, pain, etc. And also to pay Rs. 5,000 as compensation to the husband of the complainant for mental harassment meted out to him. The appellants are the hospital and the Doctor/Gynaecologist who attended the complainant.
(2.)THE case of the complainant is that she was then aged 22. She got conceived in December 1994. Since January 1995 the complainant was under observation of the 2nd opposite party/Gynaecologist at the 1st opposite party hospital. The delivery date was mentioned as 28.9.1995. She was undergoing monthly checkup at the 1st opposite party/hospital. On 16.8.1995 she was admitted at the hospital and discharged on 19.8.2005. On 30.8.1995 also she was admitted on account of Blood Pressure (BP). The 2nd opposite party/doctor examined her every day twice and another doctor i.e., Dr. Achapillai used to examine her on certain days. On 4.9.1995 on the evening at 6 p.m. Dr. Achapillai examined her. The complainant was having pain at the time and Dr. Achapillai had instructed the nurses to take her to the labour room and do the needful. On the same evening at about 6.45 p.m. she had pain and matter was intimated to the nurses who told her that there is nothing wrong. Thereafter at about 8.30 p.m. and 10 p.m. the nurses were informed that the pain has increased but they assured that there is nothing wrong. The nurses did not examine her or take her to the labour room or ascertain the foetal heart sounds or inform the duty doctor or the 2nd opposite party. After 10 O'clock the pain decreased. At 5.30 a.m. also the nurses told her that there is no problem with her. But at about 6.15 a.m. the nurses told her that there is something abnormal and shifted her to the labour room and informed the 2nd opposite party. The 2nd opposite party came and examined her and told her that the child is dead. At 9.30 a.m. she underwent surgery. She was discharged on 16.5.1995. It is the allegation that had opposite parties bestowed proper care the child would not have died. It was a male child. It was on account of the negligence of the 2nd opposite party and other staff of the 1st opposite party that the death of the child was occasioned. For treatment expenses she spent Rs. 16,000. The above sum and compensation of Rs. 4,00,000 was claimed. If at the time when the complainant had informed the nurses about the pain and had they examined the heart sounds of the baby the child could have been saved. The 2nd opposite party had told the complainant that had she been informed in time surgery could have been conducted earlier and the child saved. The 2nd opposite party did not examine the complainant in the evening on 4.9.1995 and did not enquire anything about her although she was continuously under the treatment of the 2nd opposite party.
(3.)THE 1st opposite party, the hospital has filed version denying the allegations altogether. The complainant has been given all attention by the 2nd opposite party/Gynaecologist and other staff members. On 19.8.2005, it was found that the complainant is having high Blood Pressure and she was admitted and her BP and the foetal heart sounds of the baby were continuously monitored. The services of the doctors are available in the hospital during 24 hours. There was no negligence at all. The complainant was having Pregnancy Induced Hypertension (PIH). It is a very dangerous situation. It was on account of proper treatment at the hospital that the particular illness did not result in bleeding, etc. Even now cent -per -cent successful treatment for the particular illness is not available. The complainant was made to undergo scanning, and it was found there was an infarct in the placenta. The above indicated the risk to the child. She was discharged on 22.8.1995 with the high blood pressure fully under control. She was admitted on 30.8.1995 again for high blood pressure. The BP rate and the foetal heart sounds were monitored hourly, day and night and bystander lady even objected alleging that the same is causing sleep disturbance to the complainant. On 4.9.1995 as the 2nd opposite party was on leave and in the evening Dr. Achapillai a Senior Gynaecologist examined the complainant and it was found that she was not having any problems. The nurses on duty checked the condition of the complainant and the heart sound of the child in the womb and noted in the case sheet. It is denied that the complainant was having severe pain in the evening, etc. It was only at 5.45 a.m. on 5.9.1995 the duty nurses found that the foetal heart sounds are not audible. The matter was informed to the 2nd opposite party. The 2nd opposite party immediately reached the place and as per the directions of the 2nd opposite party the complainant was subjected to the surgery. She was kept at the post -operative ward for 24 hours to assure that she is safe. It would have been on account of PIH and infarct in the placenta that the child died. It was on account of the close attention given to the complainant that she did not suffer from bleeding , etc. There was no lapse in attention or care on the part of the opposite parties. The 1st opposite party hospital has got 160 beds with all specialties and it is a charitable one.
The 2nd opposite party/doctor has filed version stating that the complainant was admitted on 19.8.1995 with oedema on ankles and high blood pressure. She was prescribed Mithile dopa for reducing the blood pressure and discharged on 22.8.1995 with BP controlled and reviewed after one week. On 30.8.1995 she has found to have high BP and was admitted for closer monitoring and necessary medicines was administered to control the BP and to prevent the complication of PIH. The foetal status was satisfactory and she was shifted to the ward. On 1.9.1995 BP was found to be high and necessary medicines were given. On 4.9.1995 at 1.30 p.m. it was noticed that BP had again gone up. She was given necessary medicines. It was instructed to check the BP regularly, to monitor foetal heart sound and inform SOS. On 4th evening the opposite party was off but had made arrangements with her senior colleague Dr. Achapillai to take necessary care of the complainant. Dr. Achapillai had examined the petitioner in the evening and found everything normal. The BP and foetal heart sound were regularly monitored till 9 p.m. and were within the normal limits. The patients normally are not disturbed between 9 p.m. and 5 a.m. unless there are specific complaints by the patients. On 5.9.1995 at 5.45 a.m. the nursing staff on routine examination noted that the foetal heart sound could not be located. Even at the time the petitioner had no complaint of any reduced foetal movement. Immediately she was shifted to the labour room. The opposite party was informed at 6.20 a.m. She reached the labour room at 6.35 and examined the complainant and confirmed the foetal death. Internal examination confirmed that the petitioner had no labour pain during the night. The observations are recorded in the case sheet. The details were explained to the patient and her relatives. The petitioner was kept in the labour room to see whether she can have a normal delivery. The petitioner was again examined at 8.47 a.m. and found that she has no proper labour pain and the uterus was irritable. The BP was normal. At 10.20 a.m. the petitioner complained of severe headache and the BP was noted to be high. Internal examination was repeated which showed no progress in labour. High BP with severe headache may lead to eclampsia a life threatening complications. The irritable uterus can be an indication of severe ante partem haemorrhage (premature separation of the placenta from the uterus) which may lead to life threatening complication. Considering all these factors immediate caesarean section was done. After operation she was closely observed in the post -operative ward to monitor BP and watch for bleeding and other necessary care. She was transferred to her room after 24 hours. The post -operative period was uneventful. She was discharged on 15.9.1995 with the directions to come back for checkup after 6 weeks or earlier if she had any problem. The opposite pary has denied any negligence or lack of care on the part of the respondent. Dr. Achapillai had not made any specific orders in the case sheet. If there were any complication Dr. Achapillai would have certainly noted the same. There is no reason for the nursing staff to ignore or disobey the instructions of the Dr. Achapillai. It is denied that the nursing staff ignored the complaints of the petitioner during the night. The complainant used to be examined by the opposite party twice a day. She was also seen by Dr. Achapillai daily. PIH is a complication occurring in pregnancy for which no foolproof treatment is available. It can lead to eclampsia, intra uterine death and intra uterine growth retardation. Eclampsia is a kind of fits occurring to the pregnant woman with complication of uncontrolled PIH. Besides the usual tests, ultrasound scanning was done to know the intra status of the baby and placenta; and the same showed placental infarct. Placental infarct will affect the growth of the baby which may lead to IUGR and later to IUD. It is denied that if surgery was conducted on 4.9.1995 the baby could have been saved. There was absolutely no indication for surgery on that day. Since the opposite party was on leave she had arranged Dr. Achapillai to examine the patient in the evening. The unfortunate IUD in the case is something which could not be detected and it is beyond human control. Since the expected date of confinement was on 28.9.1995 there was no indication for earlier intervention. Utmost care was given to the complainant. The opposite party took her Degree in Medicine in 1967 and completed Post -Graduation in Obstetrics and Gynaecology in 1975. She has worked in the Department of Obstetrics and Gynaecology in UK for 5 years and in Liverpool Maternity Hospital in UK. She was also in the Maternity Hospital, Thrissur. As consultant Gynaecologist she has got 20 years experience. She has managed thousands of deliveries and has done hundreds of caesarean operations and has got good result. She has denied any liability in the matter.

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