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--------------- Print Magazine --------------
 
  May 2016
 
  April 2016
 
 
 
 
CASE STUDY - by Anoop K. Kaushal

EVIDENTIARY VALUE OF EXPERT OPINION

Arvind Pandey v. Dr. (Mrs.) Sulekha Saran

Original Petition No. 209 of 2000 decided by the National Consumer Disputes Redressal Commission, New Delhi on 6-7-2012.

Facts: Arvind Pandey, husband of deceased Abha Pandey, for self and his minor son, Ayush Pandey as the natural guardian, alleged medical negligence on the part of 8 doctors as also against
(i) Medical Superintendent of CGHS Maternity & Gynae Hospital, (ii) Ministry of Health & Family Welfare, Government of India, and (iii) Director General, Health Services, Central Government Health Scheme, claiming a compensation of ` 25,00,000 that while his wife was being checked up at CGHS Maternity & Gynae Hospital, R.K. Puram, New Delhi at regular intervals from 10 th September, 1998 onwards, had undergone as many as eight check-ups until 10 th December, 1998, during which neither any abnormality or infirmity was either suggested or diagnosed by the attending doctors. Subsequently, during the check up on 17 th December, 1998 while no abnormality was found it was for the first time that the doctors informed her that she could not have a normal delivery and that she would have to undergo a Lower Segment Caesarean Section. On the 23 rd December, 1998 after a pre-surgery check-up and on confirmation that she was not having any complications, she was taken to the operation theatre for a caesarean section and a healthy male child was born at 10:35 a.m. At 10:55 a.m. he was asked by the doctors to arrange for two units of blood from the Blood Bank of Indian Red Cross Society, as a sudden emergency had cropped up. He rushed to collect the blood of required blood group from the Red Cross Society, where only one unit was available and when he returned to the Hospital, an ambulance was being readied as the patient had to be transferred to Safdarjung Hospital for better management, reached there at about 1:30 p.m. and the doctors at the emergency on examination stated that the patient had already expired, but no post-mortem was suggested. The complainant has alleged that the doctors erroneously diagnosed the case of his wife to be a case of caesarean section though (i) such a procedure was neither necessary nor called for; (ii) there was neglect on part of the doctors and other authorities of the Hospital as it was ill-equipped to meet an emergency; and (iii) there was total failure on part of the doctors to make provision for blood and other essential medical facilities. Besides, they failed to ensure timely, correct and proper medical help to the deceased.

Expert opinion: The Director, All India Institute of Medical Sciences constituted a medical board comprising of six medical specialists, three of whom belong to the Department of Obstetrics and Gynaecology, one from the Department of Anaesthesiology, one from the Department of Forensic Medicine with the sixth member from the hospital administration who acted as the Member Secretary, and subsequently submitted the report of the Medical Board who opined as:.

"1. The medical records available from the concerned hospital pertaining to the case do not provide enough information to determine in detail the sequence of events and the action taken by the team of doctors on the day of mishap.

2. During ante-natal period, no significant abnormality was detected. Since Patient was Rh Negative and Husband was Rh Positive, Coomb's test was prescribed and Anti-D was administered. In the last phase of ante-natal check up, deceased patient was diagnosed to be having contracted pelvis, therefore, delivery by caesarean section was planned. Pre-Anaesthetic check up was done and patient was asked to keep the donor ready.

3. During the surgery, patient developed complications like broncho-spasm and hypotension which were managed appropriately. However, patient developed severe postpartum haemorrhage for which blood transfusion was required (and blood transfusion was indicated). There was no facility of blood bank/blood storage in the hospital, therefore, the husband of deceased patient was asked to arrange it from Red Cross Blood Bank, at Parliament Street, Delhi, but arrangement of blood got delayed. Meantime, considering the deteriorating condition of the patient, subtotal hysterectomy was done as an attempt to save the life of the patient and patient was transferred to higher centre (Safdarjung Hospital) but was declared brought dead.

4. The treatment given and measures taken to save the life of the patient were appropriate and as per accepted professional practice. The doctors resuscitated the patient with available methods except blood. Even hysterectomy was done in an attempt to save the life. Therefore Board members are of the opinion that no medical negligence can be attributed on the part of the doctors. However:

a. In hind-sight, prior arrangement of blood would have been desirable.

b. Early judgment/decision to transfer the patient to a higher center could have been desirable."

Held: Service rendered by the Government employee before retirement would be 'consideration' for providing medical facilities to him or his family members. Hence, it cannot be said that services rendered by the hospital which is subsidized by the Government is rendering service free of charge.

The medical record for 17 th December, 1998 has not been produced by the opposite parties on the plea that all the medical papers were with the complainant, who has filed all the other medical records, except the record of 17 th December, 1998 just to prove his case that he had not been advised to arrange for the blood. The treating doctor had clearly stated the deceased to be a primigravida of 22 weeks pregnancy with Rh-ve factor, but had not stated that since the husband belongs to the Rh+ve factor, her pregnancy was likely to have undesirable implications and the medical records before undertaking the LSCS do not indicate that adequate information or advisory necessary to be given to a prospective mother, had been rendered. Since the opposite parties have been contending that the complainant had been advised to arrange for or keep the blood donors ready, this particular pre-operative instruction is very relevant. Had that been the case, this instruction/advisory would have found a mention with regard to the relevant blood group of the patient and the quantity that was required to be kept ready. If the hospital did not have the arrangement for the blood and considering that the elderly pregnant woman was of the Rh-ve factor, it was very necessary for the doctors to have made prior arrangement for the required blood before embarking on the LSCS. Obviously, this was not done. The opposite party/hospital is a purely maternity center undertaking delivery of children including complicated cases all-round the year. In the process, they must have encountered situations wherein even in a normal delivery, blood would have been required for transfusion to anaemic mothers. If the hospital did not have its own arrangement for the storage of blood, the least it ought to have was an arrangement with the Safdarjung Hospital or the All India Institute of Medical Sciences, which are located very close to it or even with the Blood Bank of Indian Red Cross Society, Near Parliament Street, New Delhi on S.O.S. basis, so that in case of sudden emergency blood could be arranged at the shortest possible notice. While the deceased delivered a healthy baby at 10:35 a.m., soon thereafter she developed bronchospasm, hypotension and excessive bleeding from vagina, which goes to show that it was the lack of foresight on the part of the doctors resulting in such complications, for which they had not made any prior arrangement. Dr. Sulekha Saran, who was the doctor primarily concerned for the LSCS and was the team leader, has to be held negligent. No doubt, the Medical Board constituted by the Director, AIIMS has held that the treatment given and measures taken to save the life of the patient were appropriate as per the accepted medical practice. In our view, it does not fit into the facts and circumstances of the case. The opinion that even hysterectomy had been undertaken in an attempt to save the life, again does not convince us as we are of the view that not only the LSCS without prior arrangement of blood should not have been conducted but the doctors further compounded the negligence by undertaking the hysterectomy without prior arrangement of blood. The subtotal hysterectomy performed without prior arrangement of blood aggravated the complications as the hysterectomy operation itself would have resulted in further loss of blood without any replenishment. (Final ) observations of the Medical Board by itself imply that the doctors and the hospital have failed to anticipate/foresee the contingency/complications that was so obvious to arise in this case, which they had diagnosed to be of 'high risk category'. The treating doctor failed to do what was expected of her in the ordinary course, and therefore, she alone has to be held liable and no other doctor. The hospital would (also) be primarily responsible for this lapse as had there been a blood bank, the precious life of the complainant's wife perhaps could have been saved. A lump sum compensation of ` 5,00,000 would be a just and proper award, the complainant can retain a sum of ` 2,00,000 for himself and place the remaining ` 3,00,000 in a fixed deposit in the name of his minor son till he acquires majority.

 
 
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