This is a discussion on Bhavana Nursing Home within the Hospital forums, part of the Medical category; Shaik Shabana, W/o Shaik Abdul Khader, aged about 23 years, Muslim, R/o Jagadampalli Village, Rlykodur Mandal, Kadapa District. ….. Complainant. ...
Shaik Shabana, W/o Shaik Abdul Khader,
aged about 23 years, Muslim, R/o Jagadampalli Village,
Rlykodur Mandal, Kadapa District. ….. Complainant.
Smt. Dr. V. Kameswaramma, MBBS., DGO.,
W/o Madava Rao, Medical Practioner,
Resident of New Boyapallem, Near Old Bus Stand,
Rajampet Town, Kadapa Dist. ….. Respondent.
O R D E R
1. Complaint filed under section 12 of the Consumer Protection Act 1986 seeking direction to the respondent to pay Rs. 2,95,000/- towards compensation and to pay Rs. 300/- towards costs.
2. The brief facts of the complaint is as follows:- The complainant is the house wife and she approached the respondent doctor and admitted herself in the respondent hospital for treatment and for 2nd delivery. Prior to that the complainant use to attend the respondent hospital by name Bhavana Nursing Home for monthly checkup of her pregnancy. At the time of admission the respondent doctor told the complainant that delivery would not be normal she requires caesarian operation. The complainant believed the words of the respondent and gave consent to the said operation. On 15-7-2008 the respondent conducted caesarian operation and removed the child from the womb. The complainant was in the respondent’s hospital for a period of one week and she was discharged on 21-7-2008. At the time of discharge the complainant’s husband requested the respondent doctor for furnishing the detailed report of operation. But the respondent refused to issue the same. The complainant further alleged that after discharge from the hospital she suffered with sever bleeding. Again she approached the respondent and explained her problem but the respondent did not ascertain the cause of bleeding. Simply gave treatment in usual manner. The treatment was given for a period of 15 days but no remedy for the complainant and her condition became serious.
3. The complainant husband requested the respondent doctor to refer the complainant to any other hospital as the situation is beyond her control. But the respondent doctor again conducted DNC for controlling of bleeding and she continued her treatment for a period of two months without giving any reason for severe bleeding problem. Even though the respondent continued her treatment for a period of 2 ˝ months, the complainant did not recovered and she reached almost to the death mouth due to severe continuous bleeding and the complainant was unable to move from the bed. The complainant was taken to Tirupati for expert treatment as the respondent doctor referred to Mother Hospital, Tirupati on 10-9-2008. The condition of the complainant was very serious and she was taken to Operation theater by the doctor and conducted operation and saved her life. While conducting the said operation the doctor of mother hospital Dr. Padmaja noted in her discharge summary about the irregularities committed in previous caesarian operation as 1) Sutures on uterus were opened bladder was adherent to the suture line. 2) During dissection bladder serosal tear present sutured with 2-0 chromic catgent. 3) Both tubes and ovares normal and 4) Rupture uterine scar. The doctor of Mother Hospital explained that caesarian operation was conducted in a negligent and careless manner. Because of that the complainant suffered both mental and physical.
The complainant spent huge amount during treatment for 2 ˝ months in the respondent’s hospital and also for treatment at Tirupati. Further the complainant alleged that even now she is not able to do her household works due to weakness. The Doctor of Mother Hospital advised the complainant to take rest for a period of 6 months. After operation at mother hospital, the husband of the complainant approached the respondent and asked her for explanation for her negligent treatment. But she never gave proper reply and asked him to get out. The complainant issued legal notice to the respondent claiming compensation from the respondent and the respondent gave reply notice with false allegations. The complainant alleged deficiency of service and negligence on the part of the respondent. Hence, the complaint.
4. The counter filed by the respondent stating that the complainant is put to very strict proof of all the allegations admitted that it is true that the complainant was admitted in her hospital for 2nd delivery and prior to that the complainant use to visit the hospital for ante-natal checkup. During the first pregnancy also the complainant got admitted in the hospital and after successful caesarian operation made by the respondent doctor the complainant was blessed with a healthy child. At the time of first delivery the respondent doctor clearly advised the complainant to maintain minimum three years of gap for 2nd pregnancy.
But the complainant failed to do so and got pregnancy within 14 months and she used to attend the hospital irregularly for periodical checkup during the 2nd pregnancy. After completion of 36 weeks and after scanning, blood group test, percentage of HB, clotting time etc., the complainant was advised for caesarian operation. The respondent further stated that it is correct choice of treatment for a patient who had previous caesarian section, with scar tenderness when she came to the hospital for delivery. To prevent scar dehiscence which is risky both to mother and fetus she conducted caesarian section and tubectomy on 15-7-2008. The complainant was in admission under the care of the respondent for one week till the sutures were removed and was discharged on 21-7-2008 with details of operation were mentioned in the discharge summary. The caesarian operation was conducted after getting consent in writing from the husband of the complainant. After discharge of 7 days i.e. on 28-7-2008 the complainant approached the respondent for regular checkup and there is no problem. But on 30-7-2008 when the complainant visited the hospital with bleeding trouble immediately the respondent provided best treatment of arranging blood transfusion and prescribed antibiotics and other medicines for contraction of uterus to stop bleeding.
After one week i.e. on 8-8-2008 the complainant again approached the respondent with a complaint of bleeding. The respondent made checkup. The complainant requested the respondent to refer to her some other hospital for 2nd opinion so she gave a referral to Mother Hospital, Tirupati. Again after 4 days the complainant approached the respondent and informed that her condition is good after taking treatment in Mother Hospital, Tirupati. The respondent further stated that if the sutures in uterus were not properly done, the patient would have blood immediately in the first few hours after the surgery. If there was a bladder injury, the patient would have had Haematuria but it was not happened in the present case. The respondent denied that the complainant has not visited the hospital after 2 days of discharge with severe bleeding problem. Generally bleeding during the period after caesarian section is due to sub involution of uterine blood vessel and some times due to infection.
5. On 25th day of surgery when the complainant had 2nd bout of bleeding, the respondent did D & C for removal of retained products. After seeing the legal notice issued by the complainant the respondent came to know that Laparatomy was conducted to her on 10-9-2008. The respondent denied that it is baseless allegation that she gave wrong treatment and treated her carelessly in a rash and negligent manner. The respondent further stated that regarding points noted by Dr. Padmaja, she put the diagnosis as rupture uterine scar – post caesarian operation which itself is not correct.
The rupture uterine occurs only at the time of full term pregnancy or at the time of labour because of weakness of previous scar. As per discharge summary, the uterus size is bulky. Bulky sized uterus means involution of uterus has occurred and the involution of uterus itself is almost complete, the suture line also shrinks to a very small size. After two months of caesarian section with this pregnancy sized uterus, rupture of uterine scar does not arise. At the time of admission at Tirupati the complainant’s pulse rate is normal and B.P. is also normal, it means her general condition was good at the time of admission in Mother Hospital. In post caesarian case during D & C, there might be a chance of perforation to uterine scar due to weak, tender and thin caesarian scar.
2nd point: Sutures were opened.
If the sutures would be opened, immediately there should be massive bleeding from the uterine incision in to the abdominal cavity or uterine cavity. There is no such bleeding history from the patient upto two weeks after surgery. In case bleeding occurred externally, i.e. outside uterus through opened sutures, there should be Haemoperitoneum (blood collection in the abdominal cavity), resulting in peritonitis and paralytic ileus to the patient in which patient will have the symptoms of high fever and severe abdominal pain. There were no observations of such signs Dr. Padmajas discharge summary also.
3rd point : Bladder adherence is common in post caesarian cases.
4th point : Serosal Tear of Bladder.
Serosal Tear occurs during separation of bladder in caesarian section in Hysterictomies also. But serosal tear heals within hours without any complications. The respondent further stated that the complainant has paid only Rs. 5,000/- towards surgery and hospital and Rs. 1200/- towards anesthetist and Rs. 2,500/- towards medicines. But not huge amounts as stated by the complainant. There is no any negligence on the part of the respondent in conducting the caesarian operation to the complainant. They are not liable to pay any compensation to the complainant and there is no any deficiency of service on the part of the respondent.
6. On behalf of the complainant Ex. A1 to A9 were marked and no documents were filed and marked on the side of the respondent.
7. On the basis of the above pleadings the following points are settled for determination.
i. Whether the complainant is entitled to receive the amount towards compensation from the respondent doctor?
ii. Whether there is any negligence and deficiency of service on the part of the respondent?
iii. To what relief?
8. Point Nos. 1 & 2 Heard both sides and perused the records available with the forum and forum made the following order. The complainant is the house wife, who approached the respondent doctor for treatment for 2nd delivery. Prior to the admission the complainant use to attend the hospital of the respondent i.e. Bhavana Nursing Home for monthly checkup of her pregnancy.
On admission the respondent doctor stated that there is no possibility for normal delivery and she requires caesarian operation. On 15-7-2008 the respondent doctor conducted caesarian operation to the complainant and removed the child from womb of the complainant. The complainant was discharged on 21-7-2008. The complainant stated that after two days of discharge from hospital she again attended the respondent hospital with a complaint of severe bleeding. The respondent doctor gave some normal treatment which was continued for 15 days but no relief to the complainant. Again she visited the respondent hospital with same problem of severe bleeding. The respondent doctor conducted DNC for control of bleeding. The complainant did not get any relief with D&C also. Likewise she suffered with severe bleeding for a period of 2 ˝ months. So the complainant and her husband requested the respondent doctor to refer them for expert treatment. The respondent referred them to Tirupati and the complainant was admitted in mother hospital on 10-9-2008.
At the time of admission in the said hospital the complainant’s health condition was serious and she was shifted to Operation Theater immediately and the doctor at Mother Hospital conducted operation to control the bleeding. While conducting the said operation the doctor of Mother Hospital found number of irregularities committed at the time of caesarian operation conducted by the respondent doctor. The observations noted in the discharge summary as 1) Sutures on uterus were opened bladder was adherent to the suture line. 2) During dissection bladder serosal tear present sutured with 2-0 chromic catgent. 3) Both tubes and ovares normal and 4) Rupture uterine scar. The doctor of the Mother hospital clearly explained the complainant that the caesarian operation was conducted in a negligent and careless manner because of that she suffered with severe bleeding etc.,
9. After Laparatomy the doctor advised the complainant to take rest for a period of six months. After treatment at Mother Hospital the complainant returned to Rajampet and her husband approached the respondent doctor and asked for explanation for negligent treatment. The respondent doctor gave evasive reply. The complainant issued legal notice through her advocate for claiming compensation for her negligent act and deficiency of service. The respondent gave reply notice with false allegations and she never explained anything about nature of operation conducted by her. The complainant alleged negligence and deficiency of service on the part of the respondent.
10. The respondent filed counter and denied the allegations made by the complainant except that those are specifically admitted as it is true that she was admitted in the hospital for 2nd delivery and prior to that she use to visit the hospital for ante-natal checkup. During his pregnancy also the complainant got admitted in the hospital of the respondent and after successful caesarian operation made by her the complainant was blessed with a healthy baby.
At the time of first delivery the respondent clearly advised the complainant to maintain minimum three years of gap for 2nd pregnancy. But the complainant failed to do so and got the pregnancy within 14 months and she was not attending the hospital regularly for periodical checkup during her 2nd pregnancy. After completion of 36 weeks, and after conducting all tests she was advised for caesarian operation. On 15-7-2008 caesarian operation was conducted to the complainant along with tubectomy and she was discharged from the hospital on 21-7-2008. She was hale and healthy at the time of discharge and after completion of 7 days in a routine manner she approached the respondent for regular checkup and there was no problem at that time. Again after 2 days i.e. 30-7-2008 the complainant visited the hospital with bleeding and the respondent provided treatment by arranging blood transfusion to the complainant and prescribed same antibiotics. Again after one week i.e. 8-8-2008 the complainant approached the respondent with some complaint of bleeding.
Again the respondent started treatment but out of anxiety on 9-8-2008 the complainant insisted the respondent to refer her to some other hospital for 2nd opinion and on their request she referred them to Senior Gynecologist along with history of case. The respondent denied that the complainant did not visited the respondent hospital after 2 days of discharge with severe bleeding. She stated that after caesarian operation bleeding would be there for so many days. Due to infection also there may be bleeding. On 25th day of surgery i.e. 8-8-2008 she conducted DNC also for removal of retained products. In their counter the respondent answered the points noted by the doctor at Mother Hospital, Tirupati.
11. The complainant was examined as PW1 on 8-4-2009. In Chief Examination the PW1 was asked about exhibits which were submitted by her. In cross examination by the respondent the PW1 stated that she got two deliveries. The first delivery was three years back and the said operation was held at respondent’s hospital only. For the first delivery also the respondent conducted caesarian operation and was blessed with healthy baby. The PW1 denied that the respondent did not advised her to maintain 3 years gap for 2nd pregnancy. She got 2nd pregnancy after one year six months, she use to attend the hospital at Koduru upto 5 months of Pregnancy and after that she visited the respondent every month regularly. She denied that she is not irregular in attending the hospital. She stated that she has submitted Ex. A3 which reveals the attendance to the respondent’s hospital. After completion of 9 months pregnancy they conducted all medical tests, that the respondent conducted caesarian operation and her husband gave consent to the caesarian operation. The witness stated that she has visited the respondent’s hospital after 12 days and the respondent issued some antibiotics and arranged blood transfusion.
She stayed in the hospital for two days. Again after 7 days she approached the respondent with severe bleeding and she conducted D&C and also blood transfusion and prescribed some medicines. At that time also she stayed in the hospital for two more days. On 10-9-2008 she visited mother hospital at Tirupati and she entered into the hospital by walk and at that time her blood pressure was normal. The witness denied that the respondent doctor treated her with utmost care. She stated that she has not taken treatment for 2 ˝ months in respondent’s hospital. Witness stated that she has not filed the present case to blackmail the respondent doctor for unlawful gain. She stated that she cannot say that it is normal in every caesarian operation regarding adherence of bladder as noted by the Tirupati doctor. She denied that Ex. A8 were not created for present case.
12. The complainant’s husband was examined as PW2. On examination he stated that he is doing water selling business with partnership along with one friend. The PW2 denied that the respondent has not issued any detailed report of treatment to PW1. The PW2 denied that without adequate knowledge of medicine I deposed in my chief examination regarding treatment conducted by the respondent doctor. He stated that he has incurred an amount of Rs. 1,20,000/- towards treatment and he borrowed amounts from his relatives. Ex. A1 was Xerox copy of hospital certificate with regard to delivery issued by the respondent. Ex. A2 is the Obstetric report (clinical history) in the name of the petitioner issued by the respondent. Ex. A3 is the antenatal record issued by the respondent. Ex. A4 is the discharge card issued by the respondent. Ex. A5 is the discharge summary issued by the Mother Hospital, Tirupati. Ex. A6 is the office copy of notice issued by the complainant to the respondent. Dt. 4-10-2008 with postal receipt and acknowledgement. Ex. A7 is the reply notice received by the complainant from the respondent. Ex. A8 is the bunch of medical bills (24 numbers) for Rs. 27,508/-. Ex. A9 is the paper cutting.
13. The counsel for the respondent argued that there is no any deficiency of service or negligence on the part of the respondent doctor and the bleeding problem was common in caesarian operation. To prevent the bleeding respondent doctor conducted DNC also but out of anxiety the complainant and her husband visited Tirupati. The complainant counsel filed paper cutting of Ex. A9 wherein the same respondent doctor hospital nurses conducted delivery to the patient and the patient died after delivery. The husband of the patient stated the above said fact.
14. Neither the complainant’s counsel nor the respondent counsel examined any expert doctor for evidence. The case was posted for orders on 28-5-2009. At this stage the Hon’ble Forum summoned the doctor who gave treatment doctor at Tirupati by suimotto reopening the C.C. According to recent Supreme Court Judgement on admission of medical negligence case in Consumer Fora their lordships gave Judgement in “Martin F Dissouja Vs. Mohammed Ishak reported” in I 2009 CPJ 32 (SC) in an appeal against the judgment of the National Commission dt. 22-3-2002. The Supreme Court allowed the appeal and set aside the order of the National Commission observing that the Courts and Consumer Fora are not experts in medical science and medicines substituted their own views as that all specialists. For expert evidence in the present case the Hon’ble Forum summoned Dr. Padmaja, who gave treatment to the complainant at Tirupati.
15. On 8-6-2009 witness recalled for chief examination. She was examined as PW3. She stated that PW1 visited her hospital with severe bleeding pervagina. PW1 told that bleeding was continuous since 2 months on and off. She exaplained that in Ex. A5 she mentioned that the patient presented with severe bleeding, pervagina DNC admitted due to severe bleeding planned for laproctomy. The word adherence means abnormal union of two parts. The witness denied that the PW1 asked her about caesarian operation conducted by the respondent, and she never answered that there are so many irregularities committed by Dr. Kameswaramma i.e. respondent doctor.
At the stage:- The advocate for the complainant requested the Hon’ble forum to treat the witness as Hostile, and permit to cross examination, and permission granted. The witness stated that she never stated that due to irregularities committed by Dr. Kameswaramma while conducting caesarian operation the severe bleeding was occurred. She denied that in discharge summary the finding Nos. 1 & 2 are with regard to previous doctor who conducted caesarian operation on PW1. She denied that after receiving summons from the Hon’ble Forum the respondent doctor approached her to help in this matter. The witnesses also denied that Dr. Kameswaramma and she belongs to same community. i.e. doctors community she is deposing falsehood to help the respondent doctor. On cross examination the witnesses stated that PW1 visited her hospital and she came into the hospital premises by walk. The word history mentioned in Ex. A5 means opinion of PW1 only. While conducting operation’s she noted the observations as per operative findings. She stated that it is very common in 99% caesarian cases bladder will be adherent and due to malnutrition and also due to infection there will be reasons for opening of sutches after 48 hours of surgery.
The witness accepted that her findings in Ex. A5 were noted after 2 months of caesarian operation of PW1. She denied that opening of suitches after lapse of 48 hours from the time of caesarian operation not with regard to sucher in technic but in the instant case I observed after completion of two months gap. The witness stated that due to individual healing capacity of uterus there will be possibility of opening of suichers and it differs from each and everybody. She stated that she has not observed any bleeding in uterus at the time of pre-operative findings. But she found small blood clots in the uterus. The witness denied that she has received huge amount from PW1. The witness stated that she has not observed any negligence in giving treatment to the complainant by the respondent doctor. At this stage the witness was recalled for further chief examination by the Hon’ble Forum and Hon’ble Forum imposed some questions.
Q. 1) What is the necessity in conducting DNC after cesarean?
Ans. If the patient does not response with the medical treatment DNC is the option to stop the bleeding.
Q 2) How many days after DNC the complainant approached you?
Ans. After 20 days.
Q 3) After DNC you expect immediate relief?
Ans. After DNC we expect relief from bleeding within 24 to 48 hours if there are no reasons.
Q 4) What are the reasons for appearing blood clots in the uterus after 2 months?
Ans. Could be due to endometritis.
16. By perusing the records available with the forum and the arguments heard by both counsels, and the deposition given by the treating Dr. Padmaja it is clear that the respond;ent doctor has given treatment to the complainant in a negligent manner. While putting the questions by the Hon’ble Forum the expert doctor answered that the DNC was conducted to any persons, and what was the expected time for controlling the bleedings? She answered that it will take 24 hours to 48 hours. But in the present case the respondent doctor conducted DNC to the complainant to control the bleeding but no relief and the complainant suffered for 20 days and she approached the Mother Hospital doctor for remedy. The doctor concuted laproctomy to the complainant and she got relief from heavy bleeding problem. After delivery the complainant suffered with heavy bleeding for 2 ˝ months. At the first instance she approached the respondent doctor with a severe bleeding problem she prescribed some antibiotics. But there is no relief from the said problem to the complainant. Against she visited the respondent doctor and she conducted DNC arranged blood transfusion and prescribed some medicines. But no relief to the complainant. Here we can see the negligent act of the respondent doctor, on deposition the expert doctor opined after DNC one has to get relief within 24 to 48 hours. But why the complainant has suffered for so many days?. On examination the expert doctor stated that she has observed some blood clots in uterus even after delivery of 2 months. She answered could be due to endomctrits. The expert doctor also stated that the bleeding may not be stopped even after 2 months also may be some plasanta pieces were retained in the uterus.
In normal delivery one can expect some pieces of plazanta in uterus but not in case of caesarian because in caesarian operation the doctor is opening the abdomin and they are removing the child from mother’s womb directly. In such case no one can expect plazanta pieces in the uterus. In any case the pieces were retained in uterus it shows direct negligence and deficiency of service on the part of the respondent doctor, who conducted the caesarian operation. By perusing Ex. A9 i.e. paper cutting it shows the attitude of the respondent doctor in giving treatment to the patient, who visites her hospital. The Forum has came to the conclusion that the respondent doctor has conducted caesarian operation in a negligent manner which caused much pain and mental agony to the complainant. For which the respondent doctor is liable to pay compensation to the complainant.
17. Point No. 3 In the result, the complaint is allowed, directing the respondent to pay Rs. 1,00,000/- (Rupees one lakh only) towards expenditure incurred by the complainant, to pay Rs. 20,000/- (Rupees Twenty Thousand Only) towards pain and suffering mental agony, to pay Rs. 5,000/- (Rupees Five Thousand only) towards deficiency of service and Rs. 300/- (Rupees three hundred only) towards costs, totaling Rs. 1,25,300/- (Rupees one lakh twenty five thousand three hundred only) payable within 45 days from the date of receipt of this order. The rest of the claim is dismissed.