1.    This Order shall decide both Revision Petitions Nos. RP 2583 of 2016 filed by Smt. Seema Sharma/Complainant and RP 2585 of 2016 filed by Dr. Ratna Jain/OP under Section 21(b) of the Consumer Protection Act, 1986 (the “Act”) arising from the Order dated 30.05.2016 passed by the State Consumer Disputes Redressal Commission, Rajasthan (‘State Commission’) in FA No. 71/2011, wherein the State Commission partly allowed the Appeal of the Complainant/Appellant and set aside the Order dated 20.06.2011, passed by the District Consumer Redressal Forum, Kota (‘District Forum’) in CC no. 274/05.

2.      For convenience, the parties are referred to as placed in the original Complaint before the District Forum.

3.      Brief facts, as per the Complainant, are that Complainant No. 1, who was pregnant, had first consulted OP on 08.05.2000. Later, she visited the OP every month for regular check-ups. On 27.11.2000, when she suffered from loose motions, she approached the OP, who advised her to get admitted to the Nursing Home the next day. Following the advice, she was admitted, where she was administered a Synthocinon drip to induce artificial labour pains. The drip was started at 10:00 AM and continued until 5:00 PM that day, but there was no progress in labour. On the following day, at 6:00 PM, the Complainant was again put on a Synthocinon drip. She began experiencing labour pains around 3:00 PM, which intensified by 5:00 PM. However, the OP did not examine her until 10:00 PM, at which time her consent was obtained for a forceps delivery. The baby was delivered at 10:30 PM. Unfortunately, the newborn neither cried nor responded at birth and was placed in an incubator. The baby was diagnosed with Birth Asphyxia and ultimately passed away after a few months. She thus, filed the present complaint, alleging medical negligence during labour, particularly the use of forceps, which caused injuries and deprived the baby of oxygen.

4.      In reply before the District Forum, the OP denied all allegations and stated that she had informed Complainant No. 2 and obtained consent for a forceps delivery, which she considered necessary and in the interest of the mother so as to ensure a safe delivery. While she admitted that the baby had suffered from Birth Asphyxia, she denied that it was related to the forceps delivery. The OP further argued that Birth Asphyxia could occur even in normal deliveries or Caesarean Sections. She also submitted that the Complainant had lodged a police report alleging criminal negligence, leading the police to seek an expert opinion from AIIMS. According to the Opposite Party, the AIIMS report had supported her position, concluding that delivery through forceps was neither dangerous nor risky.

5.      The learned District Forum vide Order dated 20.06.2011, dismissed the complaint with the following order:

"The facts of these rulings correlate to the facts of the current case. Therefore are fully applicable to the instant case. The arguments of the Ld. Counsel of the Respondent are logical, legal and appeared to be Judicious whereas those of the Ld. Counsel of the Complainants do not appear to be reasonable, logical or legally sustainable. The Complainants have failed miserably to substantiate their case hence the Complaint of the complainants is dismissed.

Order

The complaint of the complainants is dismissed. Parties is to bear their own cost.”

6.      Being aggrieved by the District Forum Order, the Complainant filed Appeal No. 71 of 2011 and the State Commission vide Order dated 30.05.2016 partly allowed the appeal with the following findings:-

“26.       In view of the above discussions I am of the view that Hypoxic Ischemic Excephalopathy was caused to the baby due to reasons of inducement of premature delivery in 34 weeks and inappropriate use of forceps and administration of Synthcinon against prescribed limits, which caused brain damage coupled with prolonged labour procedure. There are no indications of maternal diabetes, cardiac disease of mother, low BP, or rupture of placenta or uterus which are other common causes of HIE.

27. Ld. counsel for respondent has relied on 2010 (1) RLW Kusum Sharma Vs. Batra Hospital. In this case Hon'ble Supreme court held that doctor would be liable only where her conduct fell below that of the standard of a reasonably competent Practitioner in field. In RIW 2009 (1) 1280 SC Dr. C. D. Sreekumar Vs.S. Ramanujan it was held that so long as a doctor follows a practice acceptable to medical profession he cannot be held liable for negligence.

28.  Following the standards laid down in the above judgments it obvious that respondent's conduct fell short of reasonable care and competence expected of her.

29.  The appeal deserves to be allowed. The judgment of ld. DC is quashed and respondent is held guilty of medical negligence. The respondent is ordered to pay a sum of Rs. 15,00, 000/- as compensation to the complainants within one month of the order. Respondent shall also pay a sum of Rs. 31,000/- as costs to the complainants.”

7.      Dissatisfied by the State Commission order, both the parties i.e., the Complainant and the OP filed the present cross Revision Petitions before this Commission with the following prayer.

RP/2583/2016-filed by the Complainant- Smt. Seema Sharma

“1. That the amount of Compensation/ Award of Rs. 15,00,000/- Granted/Awarded to the Complainant against the Respondent by the State Consumer Disputes Redressal Commission, Rajasthan, Circuit Bench, Kota in Appeal No. 71/2011 be enhanced to Rs.1,25,00,000/-.

2. That any other orders/ directions be passed in favour of the Appellant against the Respondent as this Hon'ble Commission may deem fit in the circumstances of this case.”

RP/2585/2016- filed by the OP- Dr. Ratna Jain

A--That this revision petition may be admitted.

B—That the enclosed application for impleadment of the insurance company may be allowed.

C-- That the application for stay against the impugned may be allowed.

D--That the impugned order may kindly be set aside.

E—That any other order / direction may be issued as per law in the interest of justice.”

8.      The learned Counsel for the complainant reiterated the material facts and arguments previously advanced before the lower fora, emphasizing that the complainant sought a revision to enhance the compensation awarded by the State Commission from Rs. 15 lakhs to Rs. 1.25 crores. He asserted that the revision was justified considering the mental agony and suffering endured by the complainant's family over the five years leading to the child's demise. He argued that the State Commission failed to adequately account for the quantum of the family’s and child’s sufferings, erroneously concluding that the child passed away shortly after birth, disregarding the prolonged period of excruciating pain. The OP manipulated the documentation to present an idealized course of treatment, particularly by selectively quoting the AIIMS report dated 10.08.2001. He contended that the documentation relied upon by the OP, having been prepared by them, was inherently biased and deliberately excluded crucial details that would expose the deficiencies in the treatment provided. The AIIMS opinion, based on such documentation, could not, therefore, be relied upon in isolation. Further, he pointed out discrepancies between the OP’s prescription and USG reports, which indicated differing estimated delivery dates, undermining the OP's assertion that the pregnancy had reached full term.  He argued that the Syntocinon medication was used excessively and in contravention of established medical guidelines, which prescribe a maximum induction-to-delivery interval of 18 hours. In this case, labour persisted beyond this threshold without adequate monitoring or intervention, thereby necessitating a Caesarean section, yet, the OP pursued a forceps delivery, leading to the child’s birth under conditions of severe distress, ultimately resulting in Birth Asphyxia and subsequent microcephaly.  He relied on "Induced Labour" by Ian Donald, to argue that the OP deviated from standard medical protocols. The failure to monitor the fetal heartbeat adequately during prolonged Syntocinon administration was particularly egregious, as medical literature recognizes this as a critical risk factor for fetal distress. He criticized the respondent's attempt to justify forceps delivery, arguing that it was neither medically indicated nor supported by the cited medical literature. He maintained that the decision not to perform a timely Caesarean section demonstrated gross negligence, as forceps delivery under such circumstances was not consistent with accepted medical practices. In conclusion, the learned Counsel submitted that the respondent’s actions constituted a clear case of medical negligence. He sought enhancement of compensation to Rs. 1.25 crores.

9.    In his arguments, the learned Counsel for the OP doctor firmly denied any negligence or deficiency in her conduct. He elaborated on the medical concepts of gestational age and stages of labour, asserting that the State Commission had erroneously determined the gestational age to be 34 weeks instead of 37 weeks. He argued that delivery by forceps was not obsolete and was rather a medically accepted and standard method of assisted delivery. He placed significant reliance on the AIIMS opinion dated 10.08.2001, contending that there was no necessity for a Caesarean section since labour progression was adequate. He argued that forceps delivery was safe and appropriate under the given circumstances. Further, he denied the assertion that Syntocinon was administered for eight hours during both stages of labour, maintaining that the medication was used solely during the first phase of labour and not during the second stage. He emphasized that the patient had completed 37 weeks of pregnancy by 29.11.2000. He supported his arguments with expert opinions from Gynecology-Obstetrics specialists Dr. Sheela Choudhry and Dr. C.P. Sharma, as well as Paediatricians Dr. Mohan Arya and Dr. Ashok Sharda, alongside the AIIMS expert opinion report. He contended that the State Commission had misinterpreted the medical literature on record and failed to give due weight to the expert opinions presented. To substantiate his defence, he relied on Martin F. D'Souza v. Mohd. Ishfaq, 157 (2009) DLT 391 (SC); Saleemuddin and Ors. v. Dr. Sunil Malhotra, III (2006) CPJ 396 (NC); Narsimha Reddy (Deceased) & Ors v Rohini Hospital & Anr., NC, 2005 CTJ 855 (CP) (NC); Upasana Hospital & Anr. v. S. Farook, II (2007) CPJ 235 (NC); Baburao Satappa Irrannanavar v. KLE Society's Hospital & Ors., 4 (2006) CPJ 71 (NC); and Meghmala & Ors. v. G. Narasimha Reddy & Ors., (2010) 8 SCC 383. He contended that the complainant failed to discharge the burden of proof and acted fraudulently. Thus, he urged to dismiss the complaint and set aside the impugned order.

10. The main issues to be determined is whether there was any negligence or deficiency in service on part of the OP doctor in delivering the child of the complainant? If yes, is the complainant entitled to any enhanced compensation?

11.    It is undisputed that Complainant No. 1 was admitted to the said Nursing Home under the care of the OP for delivery and that a forceps delivery was performed, following which the baby suffered from Birth Asphyxia. The complainant alleged that the delivery was conducted prematurely and that use of forceps, which caused oxygen deprivation to the baby, was not needed. Instead, a Caesarean section should have been performed. She further contends that medicine Syntocinon was improperly administered and, highlighted negligence and deficiency in service on the part of the OP. The District Forum dismissed the complaint, finding no merit in the allegations. However, on appeal, the State Commission set aside this decision, and held the OP liable, thereby, awarding compensation to the complainant. The OP denied any negligence and argued that the State Commission’s order was not based on a proper evaluation of medical literature or expert opinions. Instead, the OP maintained that the decision was rooted in the State Commission’s subjective interpretation of the actions required, which remained unsupported by medical evidence. I have gone through the material on record and find that the State Commission’s decision is broadly based on the findings, that the delivery was pre mature, Caesarean section should have been performed instead of forceps delivery and medicine Syntocinon was administered twice for around 8 hours each during the first and second stage of labour which was incorrect. In M.A. Biviji v. Sunita & Ors., 2023 LiveLaw (SC) 931, decided on 19.10.2023, and drawing from the precedents set in Jacob Mathew v. State of Punjab (2005) 6 SCC 1 and Kusum Sharma v. Batra Hospital (2010) 3 SCC 480, the Court outlined the three essential elements to establish medical negligence: (1) a duty of care extended to the complainant, (2) breach of that duty of care, and (3) resulting damage, injury or harm caused to the complainant attributable to the said breach of duty. The Hon’ble Court held that, a medical practitioner will be held liable for negligence only in circumstances when their conduct falls below the standards of a reasonably competent practitioner. It further stated that due to the unique circumstances and complications that arise in different individual cases, coupled with the constant advancement in the medical field and its practices, it is natural that there shall always be different opinions, including contesting views regarding the chosen line of treatment, or the course of action to be undertaken. It acknowledged that in such circumstances, just because a doctor opts for a particular line of treatment but does not achieve the desired result, they cannot be held liable for negligence, provided that the said course of action undertaken was recognized as sound and relevant medical practice. Furthermore, it is pertinent to note that in matters of medical negligence, the expert evidence plays a vital role in determining the negligence, if any, as was observed by Hon’ble Supreme Court in SK Jhunjhunwala v. Dhanwanti Kau & Anr., (2019) 2 SCC 282, decided on 01.10.2018. In the present case, the expert opinion report from AIIMS makes it clear that forceps delivery is a permissible and widely accepted medical procedure, provided the criteria for such delivery is met. It is established that forceps delivery is considered safe if the baby is fully mature, typically at or beyond 37 weeks of gestation. The complainant's last menstrual period was recorded as 15.03.2000, which clearly indicated that by 29.11.2000, the gestational age of the baby was 37 weeks, contrary to the erroneous conclusion of the State Commission. Therefore, the performance of a forceps delivery in this instance was medically justified and in accordance with the observations made in the report given by AIIMS, Delhi. Consequently, the finding of the State Commission regarding the administration of injection Synthocinon prior to 37 weeks is also incorrect. Medical literature supports the use of this injection in cases where labor is not progressing adequately. It is commonly prescribed to stimulate or augment contractions when the natural progression of labor is insufficient or when cervical dilation is inadequate to facilitate the baby's movement through the birth canal. In the present case, it is undisputed that the complainant experienced difficulty in labour. Consequently, the OP administered Synthocinon, a medicine deemed safe under the circumstances, in fulfillment of her duty of care. The final issue pertains to the duration of Synthocinon administration. The report by AIIMS noted that in the first stage of induced labor, this medication can be administered safely for 8-9 hours, but subsequent doses should not exceed one hour. The State Commission found that during the second stage of labour inducement, Synthocinon was allegedly administered for an additional 8 hours, resulting in prolonged labor and complications affecting the baby’s health. However, no substantive evidence was presented to corroborate this claim apart from the complainant’s statement. It is an established law that, the primary burden of proving negligence rests with the complainant. In the absence of such proof, mere occurrence of an adverse outcome does not suffice to establish liability on the part of the OP, particularly when standard medical procedures were adhered to with due care. Moreover, the complainant has failed to present any new grounds warranting further enhancement of compensation in this matter.

12.    Based on the discussion above, I do not find merit in the Revision of the complainant as the burden of proof for proving negligence is not met. There were clear irregularities with the findings of the State Commission. Therefore, the District Forum order dated 20.06.2011 is reinstated and the complaint against the OP is dismissed. Consequently, RP 2583 of 2016 filed by Smt. Seema Sharma/ Complainant is dismissed and RP 2585 of 2016 filed by Dr. Ratna Jain/ OP is allowed.

13.    There shall be no order as to costs.

14.    All pending Applications, if any, stand disposed of accordingly.