C S I MISSION HOSPITAL Vs. THIRU RAMACHANDRAN

JUDGEMENT

(1.) The admitted facts of this case are follows: The complainant's wife who was pregnant, was admitted as an in-patient in the hospital of the opposite party on 16.7.1997 around 10.30 a. m. She had a normal delivery around 4.30 p. m. But the child, according to the opposite party, was severely asphyxiated and, therefore, was taken to the nursery. Thereafter the complainant's wife had profuse bleeding and, therefore, she was taken to the emergency ward and a sub-total hysterectomy was performed. However, the complainant's wife died in the early hours of 17th July viz. , around 00.30 hrs. The complainant, alleging negligence and deficiency in service, approached the Lower Forum which accepted the complainant's case and granted a compensation of Rs.1 lakh and cost of Rs.500/-. The Ist opposite party, therefore, has come forward with this appeal. Admittedly, it is the 3rd opposite party who attended upon the complainant's wife and who performed the surgery. The 2nd opposite party had nothing to do with this. Though the 2nd opposite party is attached to the 1st opposite party hospital, on 16.7.1997 she was away and, therefore in her place it was the 3rd opposite party who came in and thus attended upon the complainant's wife. The lower Forum though rightly dismissed the complaint as against the 2nd opposite party, erred in dismissing the complaint against the 3rd opposite party viz. , the Doctor who performed the surgery and who actually attended upon the complainant's wife during the surgery. But fortunately for the 3rd opposite party, the complainant has not chosen to come up with an appeal. It is only the 1st opposite party who has now preferred this appeal.

(2.) It is not the case of the opposite parties that the complainant's wife had any problem with regard to her health in that she was a normal person. She did not have any blood pressure problem. She was not diabetic. She did not have any vascular or cardiac problem. Excepting for the fact that she was in an advanced state of pregnancy and was expecting the child any moment on the date of her admission in the hospital, she was a woman with normal health, without any medical complication. It is admitted that she had a normal delivery. That is also noted in the case sheet. It is not explained as to how the child delivered was severely asphyxiated. It is not the case that the umbilical cord was found twisted around the child's neck. Nor it is the case that the contraction and dilatation was not full. Therefore, how the severely asphyxiated condition of the child came about, is not explained by the opposite parties. Leaving alone that, it is admitted that after the delivery, the complainant's wife had severe post-partum haemorrhage. How and why this happened, is also explained either in the version or in the evidence of the 3rd opposite party. It is also not explained or stated that the post-partum haemorrhage (PPH) is an inevitable consequence of labour. If the post-partum haemorrhage had occurred, it must be attributable to certain reasons. It is not stated that such an occurrence is not uncommon in the course of post-parturition.

(3.) The next glaring aspect is the death of the complainant's wife. According to the opposite parties, as there was profuse bleeding they shifted her to emergency ward and they transfused nearly 10 bottles of blood and carried out sub-total hysterectomy. They shifted her to the I. C. U. at 8.45 p. m. and the patient died at about 12.40 p. m. viz. , 00.40 hrs. on the 17th. The cause of death is mentioned as disseminated ultra vascular coagulation and adult respiratory distress syndrome. Therefore, something has gone wrong with the operation. Something had happened behind the closed doors. Neither the complainant nor his relations were allowed inside. Therefore, as to what had happened inside the operation room and how and why the death had taken place, it is for the opposite parties to explain. The burden in such cases shifts to the opposite parties. For, it is within their knowledge as to what had happened inside the operation theatre. The complainant cannot be expected to know as to what really happened in the operation theatre. It is for the opposite parties to show that necessary skill was employed and the procedure accepted by the profession was followed and the necessary precautions were adopted. But in this regard, we do not find any evidence much less of satisfactory nature from the opposite parties. It is practically the death of a patient at the hands of a Doctor. How it happened is for them to explain. In the version filed by the opposite party Nos.1 and 2, there is nothing stated. They have not stated even about the nature of operation, procedure and the precautions that were adopted by them. They simply narrated the events that took place. They never stated anywhere in the version as to how this condition of disseminated ultra vascular coagulation came about and what was the cause that led to the adult respiratory distress syndrome and how and why it was beyond their control. It is for them to explain as to exactly what had happened and how it happened. Therefore, it is clear that the opposite parties are not in a position to give any acceptable reasons for the deterioration, complication and ultimate death of the patient. Therefore, in the peculiar circumstances, the burden is upon the opposite parties and they have failed to discharge the burden. The lower Forum has given a number of reasons, about five in all, for coming to the conclusion that there is deficiency in service. In the case sheet, certain notings have been made and the 3rd opposite party in the cross examination has clearly admitted that they were wrong. When they found the complainant's wife bleeding profusely after delivery, it appears that immediate steps were not taken to control the bleeding or make arrangement for transfusion of blood. On the other hand, with regard to the number of bottles of blood transfused or from where they were obtained, there is some telling contradiction in their case. The lower Forum has also held that there was not enough provision for supply of oxygen to the patient and that is pointed out prominently by the lower Forum. It is also pointed out by the lower Forum that there is nothing to show that the 3rd opposite party was present at the time of delivery. On the other hand, she had allowed a staffer to attend to the delivery and that there was some lack of care in cutting the umbilical cord and in the removal of placenta. These points made out by the lower Forum are borne out and are established by a look at the case sheet. According to the opposite party, the baby died due to hypoxia at 2 p. m. on 18.7.1997. There are corrections in the Nurse's Daily records dated 16.7.1997 with regard to the time and the notings are found in different handwritings. As on 16.7.1997 it is noted that the baby was received from the Labour Room with severe asphyxia and it was not crying. The complainant's case is that they informed them that the child was not making any sound or crying and they were not allowed to see the baby and they were informed that the baby was kept in incubator. But the case sheet does not mention anything about the baby being put in an incubator. It only mentions "i. V. drips started. " At 11 p. m. it is mentioned that the baby is taking feed well. Then it is struck off and it is written that "the baby is on I. V. infusion. The baby is not active; secretion sectioned out. " Again it is mentioned at 12.15 p. m. on 17.7.1997 that "the baby had fits for few minutes. It is only at 2.10 a. m. on 18.7.1997 it is written as follows: "baby has severe grunting. Abdominal distension. Baby have no cry, Baby is not active. " why we are pointing out to this nothing in the Nurse Daily Record is only to show as to how the case sheet has been corrected and how the case sheet does not support the case of the opposite parties. An analysis of the evidence of the Doctor during the cross-examination would also show that the allegation of deficiency in service is well-founded. She admits that the complainant's wife was in good condition on 15.7.1997. It is noted as Blood Pressure at 100/70. There are some notings which were definitely not done by the 3rd opposite party. Then there is a noting stating "not willing for admission. Review on 17/7". Immediately following it, the date is mentioned as 16.7.1997, and it is mentioned as B. P.100/80 on admission. Thus a perusal of Ex. B-4 would show that it cannot be relied upon. It is admitted by the 3rd opposite party that after admission, till the time of her delivery, there were no entries in the case sheet to show her condition. She admits that if it is noted in Ex. B-4 that the umbilical cord and placenta were expelled naturally, it is wrong. She further states that the notings made in page 2 that the development and physical complications were informed to the Doctor are erroneous. She has not stated in her evidence that she attended to the delivery. But she simply states that when the patient delivered, she was present. Though she states that immediately after seeing profuse bleeding, she took steps to control it and had noted the same in the case sheet, we do not find any such notings. She, of course, denied the suggestion that the profuse bleeding was due to the fact of cutting the umbilical cord or general organ was injured resulting in profuse bleeding. In her evidence she has nowhere stated about profuse bleeding. According to her she began the process in the operation theatre and after diagnosis when it was found that the bleeding was from the uterus, they decided to remove the uterus and for which the hysterectomy was done. She further states that after the said surgery, there was again profuse bleeding where suturing was done and from the place where the operation was done, and to compensate the blood loss, blood was obtained from the blood bank and other relations of the complainant. She admits that there was enough oxygen in the hospital and she also states that if it is stated that the complainant was sent to fetch it from outside, it is erroneous. It is also admitted by her that plasma was not available with them and, therefore, Dr. Dominic sent the complainant to fetch it from outside and that plasma was not given since it was not available. She also states that they have a blood bank, but they did not have stock of plasma. The post-partum haemorrhage (PPH), the condition of the baby at birth all suggest that the patient was suffering from Hepatitis E for which she was neither tested nor treated. Therefore, an analysis of the evidence of the 3rd opposite party would show that there was lack of care and necessary skill was not exhibited nor employed while dealing with the complainant's wife. Therefore, we do find any reason to differ from the view taken by the lower Forum.