Case No.785/05

1. Rajneesh Bhella

2. Baby Harmeet through her next friend and natural guardian (her father Sh.Rajneesh Bhella).

Both residents of RZ-D-3/46, Vinod Puri, Vijay Enclave, Palam-Dabri Road, New Delhi – 45.

………Complainants

Versus

1. Dr. Bindu Nandwani (Director of Sharma Hospital) at present R/O B-89, G.F. Jeewan Park, Uttam Nagar, New Delhi – 110059.

2. Sharma Hospital, C-39, Milap Nagar, Uttam Nagar, New Delhi – 59 through its Medical Director.

3. Kalra Hospital, A-6, Kirti Nagar, New Delhi – 15. Through its Medical Director/Concerned Physicians : Dr.R.N. Kalra/Dr. V. Kalra.

……..Opposite Parties

CORAM : J.P. SHARMA : PRESIDENT

: S.M. MAZUMDAR : MEMBER

: DR. PREMLATA : MEMBER

O R D E R

J.P. SHARMA (PRESIDENT) :

Brief facts of this case are that Late Smt. Sunita Bhella w/o complainant No.1 died at 7.00AM on 02.11.2005 at Kalra Hospital, Kirti Nagar, New Delhi, that Smt. Sunita Bhella was examined and reported four months pregnant on 25.05.2005 by Dr. Pinki Sharma, M.D. Consultant Obstetrician & Gynaecologist and as prescribed by Dr. Pinki Sharma, the deceased was taking necessary medicines and other precautions, that as per advice of Dr. Pinki Sharma, Smt. Sunita Bhella had undergone some medical tests like Ultrasound, Urine, Blood etc. and that Dr. Pinki Sharma pronounced the expected date of delivery as 31.10.2005.



On 25.05.2005, on the advice of Dr. Pinki Sharma Smt. Sunita Bhella underwent certain medical tests which are stated below with the reports regarding the same :-

(i) ULTRASOUND LOWER ABDOMEN OBSTR : The report shows that a single live fetus of 16 weeks and 5 days age present and reported Expected date of Delivery as 04.11.2005.

(ii) HAEMATOLOGY : The report shows Haemoglobin as 10.8 gm% which is under normal values. Blood Group reported as O+. Blood sugar Random was reported as 86mg/dl, which is under normal values. And Urine Sugar Random was reported NIL.

(iii) IMMUNOLOGY-SEROLOGY : V.D.R. : The report was normal.

(iv) URINE EXAMINATION : The report was normal.

(v) HIV (AIDS) ANTIBODY I & II : The report was normal.



Subsequent medical examination also revealed that the weight of fetus was 2.65Kg. which was normal as per foetus weight. Smt.Sunita Bhella as such was perfectly normal, healthy, hail and hearty and was leading a normal life till 06.10.2005.

On 07.10.2005, Smt. Sunita Bhella suddenly developed high fever for which she was treated at Sharma Hospital (OP-2) and was discharged on 10.10.2005. However, due to fever Smt. Sunita Bhella was again admitted at OP-2’s hospital on 13.10.2005 and on this occasion OP-1 Dr. Bindu Nandwani subjected Smt.Sunita Bhella to some medical tests and declared that she was suffering from Dengue fever. Just after about two hours of the admission, OP-1 Dr. Bindu Nandwani, Director of OP-2 hospital advised the complainant and other family members of deceased that an urgent operation was required to be performed in order to save the life of Smt.Sunita Bhella and the child in womb. By that time Smt.Sunita Bhella was only eight months pregnant. However, during subsequent medical tests at Kalra hospital, she was not found suffering from Dengue fever.



One of the grievance of the complainant is that Dr.Bindu Nandwani, OP-1 claimed to be M.D. in Obstetrician/Gynaecology though lateron she was found to be merely a B.A.M.S. According to the complainant, Dr.Bindu Nandwani assured that the operation would be performed by her with the assistance of some experienced doctors without disclosing their names. Accordingly, Smt.Sunita Bhella was subjected to be pre-mature caesarian operation on 13.10.2005 which started at about 19.30 hours and lasted for about 2.5 hours and a female baby was born. The weight of the baby at the time of her birth was 2.535Kg. Since the baby was born pre-mature, she was very weak and on account of OP-2 Sharma Hospital being not adequately equipped had to be immediately shifted the same day to another hospital namely “Shishu Sadan” situated at Tilak Nagar where she was kept for about three days. The doctors at Sharma hospital who were treating Smt.Sunita Bhella were unable to control excessive bleeding caused by caesarian operation but she had been given only one Unit of blood. Without the consent of complainant, Smt.Sunita Bhella was shifted by Dr.Bindu Nandwani to Kalra Hospital located at Kirti Nagar on 15.10.2005 at 6-7PM where she was taken to ICU. On account of subsequent complications having developed Smt.Sunita Bhella was subjected to dialysis from 16th Oct. to 31st Oct., 2005 as both the kidneys of Smt.Sunita Bhella were not functioning. There at Kalra Hospital, Smt.Sunita Bhella was transfused about 20 Units of blood. Excessive bleeding led to low Blood Pressure. Smt.Sunita Bhella after caesarian operation contracted infection due to poor clinical condition in the Operation Theatre of Sharma Hospital. Though the doctors at Kalra Hospital did their level best to relieve the patient from infection and revive her kidneys, she did not show any sign of improvement and ultimately expired on 02.11.2005. According to the complainant, it was this severity and high degree of infection acquired by Smt. Sunita Bhella during Caesarian operation which led to Septicaemia and ultimately resulted into her death. Complainant states that the patient Smt.Sunita Bhella died on account of negligence/omissions on the part of Dr.Bindu Nandwani of Sharma Hospital and hence, the present complaint has been filed by the complainant against OPs. including OP-3 Kalra Hospital. However, during arguments negligence and deficiency in service against Kalra Hospital was not pressed on behalf of the complainant.



Joint written statement was filed on behalf of OPs. 1 and 2 i.e., Dr. Bindu Nandwani and Sharma Hospital. OPs. 1 and 2 pleaded that the present complaint is totally false and baseless which has been synthesized on the basis of unscientific laymen conjectures, misbelieves, assumptions and presumptions and that the fact remains that the complainant do not know the deceased’s pathology from which the patient was suffering from. According to OPs. 1 and 2 there was no negligence on their part and the complaint was liable to be dismissed.



OP-3 in their written statement have denied the averments of complainant against them and have pleaded for dismissal of the complaint being devoid of any merit.



During enquiry proceedings a reference was made for expert medical opinion to RML hospital. In their report the Members of the Medical Board replied the queries sent by the Forum as under :-

“Q.1 Whether B.A.M.S. degree holder can perform and/or assist L.S.C.S. surgery as per rules/law prescribed?

Ans. The Board cannot answer this question as they are not aware of the degree of surgical training imparted to a B.A.M.S. degree holder. The same can be asked from the authorities awarding B.A.M.S. degree.



Q.2 Whether it is proper to undertake L.S.C.S. surgery at a hospital which is not equipped with Ventilator or children nursery?

Ans. It is not compulsory to have ventilator and well equipped nursery in a hospital undertaking patients for L.S.C.S. However, if mother is high risk or one is expecting that new born maybe in compromising state at the time of birth, it is preferable to shift the pregnant mother before delivery to a centre which has ventilator and children nursery.



Q.3 Whether on the basis of case sheets of Sharma Hospital L.S.C.S. operation was necessary?

Ans. Patient was examined by an Obstetrician and there was evidence of fetal distress. So as per records, L.S.C.S. was indicated.



Q.4 Whether the blood investigation reports on record indicates sufficient blood supply for L.S.C.S. operation? If not, what could be the consequences of L.S.C.S. surgery of a patient in such a situation?

Ans. Patient required emergency L.S.C.S. and her pre- operative Haemoglobin was 9gm%. She was given 1 Unit of blood after the surgery. Her Haemoglobin after the surgery was 9gm%. It indicates blood replacement was done in pre-operation to the blood loss.



Q.5 If the weight of the fetus has been 2.65Kgs.+/-2S.D as per USG report whether it can be said that the patient was suffering from IUGR.]

Ans. The weight of newborn baby was 2.65Kgs. patient was not suffering from IUGR according to standard guidelines.



Q.6 What could be the possible source of Septicaemia as per case sheets available on record regarding this case?

Ans. Possibility is that patient had low immune status due to fever (? Dengue) in the antenatal period. Patient probably acquired secondary bacterial infection - ? UTI during the surgical procedure (inherent risk of surgical procedures) and this possibly could have led to Septicaemia.”


Parties filed affidavits in support of their rival contentions.

We have heard Sh.L.R. Goyal- Ld. Counsel for complainant, Dr. Bindu Nandwani – OP-1 in person, Sh.M.C. Gupta- Ld. Counsel for OPs. 1 and 2, Sh.D.P. Singh – Admn. Officer for OP-3, have gone through the material on record and have considered their relevant contentions.



At the very outset, we would like to observe that a case of medical negligence/deficiency in service on the part of OPs. 1 and 2 in this case is clearly made out. Complainants in this case have pleaded that Dr. Bindu Nandwani, Director of OP-2 Sharma Hospital claimed to be M.D. in Obstetrics & Gynaecology and had assured that the said operation would be performed by her with the assistance of some other experienced doctors whose names were not disclosed to them. In support of the complaint, complainant has filed his affidavit to this effect. During arguments, OP-1 Dr. Bindu Nandwani frankly admitted that she was merely a B.A.M.S. One of the questions sent to the Medical Board for opinion had been whether B.A.M.S. degree holder can perform and/or assist L.S.C.S. surgery as per rules/law prescribed? The Medical Board replied that they cannot answer this question as they are not aware of the degree of surgical training imparted to a B.A.M.S. degree holder and that the same can be asked from the authorities awarding B.A.M.S. degree. However, the fact remains that according to the complainant Dr. Bindu Nandwani instead of declaring herself to be B.A.M.S. only, declared before him to be an Obstetrician & Gynaecologist. The written statement filed by Dr. Bindu Nandwani jointly with OP-2 – Sharma Hospital shows that she admits herself to have treated late Smt. Sunita Bhella alongwith other doctors throughout her stay in Sharma Hospital. The mis-representation by Dr. Bindu Nandwani to the complainant that she was an Obstetrician & Gynaecologist amounts to serious mis-conduct on her part and her having treated the patient in such a critical condition obviously amounts to deficiency in service and mal-practice prevalent at Sharma Hospital.



One of the queries sent to the Medical Board has been as under :-

“Q.2 Whether it is proper to undertake L.S.C.S. surgery at a hospital which is not equipped with Ventilator or children nursery?

Ans. It is not compulsory to have ventilator and well equipped nursery in a hospital undertaking patients for L.S.C.S. However, if mother is high risk or one is expecting that new born may be in compromising state at the time of birth, it is preferable to shift the pregnant mother before delivery to a centre which has ventilator and children nursery.”





In reply to the above querry, the Medical Board has clearly stated that if the mother is high risk or one is expecting that new born may be in compromising state at the time of birth, it is preferable to shift the pregnant mother before delivery to a centre which has ventilator and children nursery. In the present case, deceased Smt.Sunita Bhella a few days before her admission at Sharma Hospital on 13.10.2005 was admitted because of high fever on 07.10.2005 at Sharma Hospital and was discharged from there on 10.10.2005. Just after two days of her discharge she had to be readmitted at Sharma Hospital due to fever. Admittedly, she was about eight months pregnant at that time and Dr. Bindu Nandwani, OP-1 in such a situation advised the complainant and other family members of the deceased that an urgent operation was required to be performed in order to save the life of Smt.Sunita Bhella and the child in womb. Obviously, the medical status of Smt.Sunita Bhella falls within the category of high risk on account of her having suffered high fever just few days before when she was suspected to be suffering from Dengue and in such a case as per the remarks of Medical Board, it was preferable to shift the pregnant mother before delivery to a centre which has ventilator and children nursery. Further, the new born was in a compromising state for the simple reason that Smt. Sunita Bhella was only eight months pregnant when the alleged emergency caesarian operation was undertaken at Sharma Hospital which was neither equipped with ventilator nor with Children Nursery. Admittedly, the new born child due to his critical condition had to be referred to “Shishu Sadan” immediately after delivery and the venture on the part of Dr. Bindu Nandwani to subject such a patient to caesarian operation at her hospital when she was only a B.A.M.S degree holder makes out a case of medical negligence on her part besides a case of deficiency in service. It is a proved fact on record that Smt.Sunita Bhella was transfused 20 Units of blood at Kalra Hospital where she had been subjected to dialysis also due to failure of her both kidneys. Failure of kidneys on account of low blood pressure/flow is most imminent. According to OPs. 1 and 2 on admission on 15.10.2005 at about 3.00 PM the Blood Pressure of Smt. Sunita Bhella fell as low as 80/60.



Reply of Medical Board to querry No.5 was as under :-

Q.5 If the weight of the fetus has been 2.65Kgs.+/-2S.D as per USG report whether it can be said that the patient was suffering from IUGR.]

Ans. The weight of newborn baby was 2.65Kgs. patient was not suffering from IUGR according to standard guidelines.





Then reply of Medical Board to querry No.6 was as under :-

Q.6 What could be the possible source of Septicaemia as per case sheets available on record regarding this case?

Ans. Possibility is that patient had low immune status due to fever (? Dengue) in the antenatal period. Patient probably acquired secondary bacterial infection - ? UTI during the surgical procedure (inherent risk of surgical procedures) and this possibly could have led to Septicaemia.”


Smt. Sunita Bhella was referred to Kalra Hospital after she had suffered serious infection during caesarian operation at Sharma Hospital. As per record, the cause of death of Smt. Sunita Bhella had been Puerperal Septic shock with MOSF. In the case reported as III(2004)CPJ 29 (NC) Dr. Kaligounden Versus N. Thangamuthu Hon’ble National Commission in clear terms observed that if the patient has recently had an operation, one should be very unwilling to consider any other source of Septicaemia except surgery. Even the Medical Board in its report has observed that possibility for Septecaemia in this case is that the patient had low Immune Status due to fever (? Dengue) in the Antenatal period. Further in reply to querry No.6, the Medical Board observed that the patient probably acquired secondary bacterial infection - ? during surgery procedure and this possibly could have led to Septicaemia. We have also observed above that OP-2 Sharma Hospital was not well equipped and that medical status of Smt.Sunita Bhella was very poor at the time she was subjected to Caesarian operation and since in this case the source of infection was caesarian operation conducted at Sharma Hospital, a case of medical negligence and deficiency in service on the part of OPs. 1 and 2 stands established beyond reasonable doubt.



The material on record shows that more than Rs.3.00 lacs were spent by the complainant on the treatment of Late Smt.Sunita Bhella. As a result of what has been discussed above, we hold OPs. 1 and 2 both guilty of medical negligence and deficiency in service on their part. Smt. Sunita Bhella expired at the age of 24 years. Keeping in view that a household lady has to render 24 hours services to her family and that she has left behind a newly born female child to struggle in this world without mother because of medical negligence on the part of OPs. 1 and 2, adequate compensation in this case is required to be awarded to the complainants.



Accordingly, we direct both OPs. 1 and 2 to pay a consolidated amount of Rs.7.00 lacs to the complainants towards compensation, mental tension and cost of litigation. Out of the amount of Rs.7.00 lacs, a sum of Rs.3.00 lacs would be payable to complainant No.1 i.e., Rajneesh Bhella and Rs.4.00 lacs would be payable to complainant No.2 i.e., Baby Harmeet which amount would be kept in Fixed Deposit in her name in some Nationalised Bank for a period which expires three years after she attains the age of majority. During the period of her minority, monthly/quarterly interest would be payable to complainant No.1 for her maintenance but after she attains the age of majority, the amount of interest and then after three years entire amount shall be payable to Baby Harmeet i.e., complainant No.2. The liability to pay the aforesaid amount to the complainants by OPs. 1 and 2 would be both joint and several.



OPs. 1 and 2 shall comply with the above mentioned order within 30 days of its receipt failing which proceedings u/s 25/27 of Consumer Protection Act may be initiated against them.



A copy of this order as per the statutory requirements be forwarded to the parties free of charge. Thereafter, the file be consigned to the Record Room.