ORDER

SRI.H.R. SRINIVAS.  PRESIDENT

1.      This is the Complaint filed by the Complainant against Opposite Party (herein referred to as OP) under section 35 of the Consumer Protection Act 2019 for the deficiency in service and for medical negligence in treating the complainant when she visited OP and for payment of hospital charges, cost of medicines, blood transfusion charges incurred in other hospital to the extent of Rs.27,62,003/, for damages of Rs.5,00,000/- for causing her mental agony and financial expenses and for Rs.2,00,000/- towards meeting oxygen expenses for the entire life of his child and for  such other reliefs as the Hon’ble District Commission deems fit.

2.      The brief facts of the complaint are that; OP -1 is a prime care hospital providing medical facilities to the patients. One Dr.Noor Ul Ayain is the consultant gynecologist in the said hospital.  Eversince the complainant became pregnant she was consulting the said doctor in the said hospital from 06.02.2020. The doctor represented that they would provide best treatment and safe manner delivery of the baby.

3.      On 15.05.2021 she developed unbearable pain in her stomach and lower abdomen region. The complainant contacted directly for an appointment to the said doctor. The reception told her to pay Rs.600/- towards consultation charges which she paid online but she never received any call from the doctor to visit the hospital for consultation.  Since she was unable to bear the pain and that the specialist doctor would attend her in the hospital, in spite of COVID 19 situation she went to OP’s hospital at 1 pm in the afternoon. A duty doctor attached to the said hospital one Dr.Bhavana attended her and called the specialist examined her and administered medicine. But to her dismay, the duty doctor informed the complainant that she is having acidity only and she informed that she consulted Dr. Noor UR Ayain about the medicines to be given  and administered medication and intravenous injection for acidity. When the complainant complained the persistence of the pain even after taking medicine, duty doctor without conducting any test and advising for scanning, physically examined the complainant by inserting her hand into be complainant’s vagina more than 3 to 4 time to know the position of the baby in the womb. In the process, it caused severe pain and bleeding from that region. The same was noticed by her husband.  The duty doctor and the nurses of the hospital were not attending the complainant properly and exercising the required care and skill and were Callous and indifferent and signaling that the complainant to  leave the hospital as soon as possible and they treated the complainant as an outpatient only.

4.      After spending more than five hours taking life risk, the complainant was informed by the duty doctor to undergo scanning and come on Monday i.e. 17.05.2021 since 16.05.2021 was a Sunday, for further diagnosis and treatment. Complainant and her husband lost hope and trust with the hospital and of the doctor of getting a proper and good treatment and the complainant unable to bear the pain due to heavy loss of blood and for falling unconscious occasionally, fearing life risk of herself and the baby in the womb, they decided to go for another hospital by name Specialist hospital in Kalyan Nagar. There one Dr. Usha MR examined the complainant and informed the complainant and her husband that the baby in the womb was separate in the pipe and there was massive blood rush in the complainant’s vitreous which is termed as “Placenta Abruptio” which has to be operated immediately otherwise the wife of mother and the baby would be at risk and referred to Cloud Nine Hospital, situated at HRBR layout, Outer Ring Road, Horamavu, Bangalore were NICU facility was also available.

5.      Upon reaching the said hospital at 19.15 hours (7.15 pm), the doctor at the hospital immediately attended the complainant, found that there was a lot blood loss and baby was separated from the food pipe in the womb and immediately took her to the operating theater and took up the baby alive which needed oxygen support. 

6.      The doctors at Cloud Nine Hospital expressed to the complainant and the husband that doctor at OP hospital did not diagnosis the problem correctly and administered wrong medicine and injection carelessly and physical examination by the duty doctor at OP’s hospital caused heavy bleeding which affected the baby in the womb and baby after its birth is suffering from lack of oxygen as the pipe was separated from the baby while in the womb.  Even after discharge from the Cloud Nine Hospital, the child was to be hospitalized on many occasion for various complications caused due to wrong diagnosis by OP doctor and wrong physical examination of the complainant. 

7.      Herself and her baby had to incur Rs.27,12.003 as hospital expenses from 15.5.2021 to 10.09.2021 at Cloud Nine Hospital.  In the said hospital multiple blood transfusion around 8 bottles of blood costing of Rs.50,000/- was done as the hemoglobin and the platelets of the complainant fallen extremely low.

8.      Even after discharge, the child is on support of oxygen even at home, for which complainant has to incur expenses of Rs.3,500/- per month for oxygen concentrator, Rs.5,000/- towards two oxygen cylinder, Rs.4,000/- to purchase pulse oxy meter, and Rs.15,000/- towards HFNC machine. All these things happened due to the negligent act, careless attitude and wrongly diagnosing and administering medical which has created life threat to the mother and baby.  No expert doctor is willing to  give her expert opinion regarding what happen to her in the hospital and hence it is not possible to provide the expert evidence. The cause of action arose on 15.05.2021 when she visited the hospital of the Op for her abdominal pain and subsequently when OP duty doctor did not take proper care and attention and wrongly diagnosed and wrong medicines administered and prayed to allow the complaint and order to pay compensation as claimed in the complaint.

9.      Upon service of notice, OP-1 appeared before the commission and contended that the complaint is not maintainable either in law or on facts and liable to be dismissed by imposing punitive cost. This complaint is filed on false, frivolous and vexatious grounds.  It has denied that the complainant eversince from 06.02.2020 is with consultation of the doctor of OP but admitted that she had an appointment for routine checkup on 06.02.2021. It has admitted that complainant visited OP hospital on 15.05.2021 as it was necessary for her as per the terms of the appointment but wrongly mentioned the time of visit.  She visited the hospital at 1.30 pm on that day.  She was informed that the specialist doctor was on leave on 15.05.2021 and since complainant initially requested for casual consultation with a normal condition for minor abdominal pain, and as there was medical emergency the complainant visited the hospital personally at 1.30 hours and examined by the duty doctor.  As per the telephonic instructions given by the experts specialist doctor as the complainant was having normal symptoms and was having normal abdominal pain with symptoms like vomiting and nausea proper medication such as, injections like Pantoprazole, Ondansetron & MVI and PV examination were made and found everything normal and the same was consented with the complete knowledge of the complainant and her husband.  The initial symptoms of the complaint was well addressed by the hospital and complainant was feeling better. 

10.    Again at 3.25 pm complainant started feeling abdominal pain and informed the duty doctor who administered an injection Biscopan and went for Second PV examination.  Which shows that OS closed, no bleeding/no show  and complainant was requested to have ultra sound scanning for upper abdomen along with growth scan of the baby, this was about 3.25 pm.  At that time, the husband of the complainant did not took her to the scanning and created ruscus in the hospital and even with the management of the hospital and finally at 4.23 pm, by clearing the bill of the hospital, took the complaint to another hospital.  This fact has been clearly suppressed by the complainant and created their own story. OP has no personal knowledge regarding as to where the complainant was taken after leaving its hospital and also do not know what kind of examination and treatment was done in the other hospital. It is also not within the knowledge that the complainant was taken to Cloud Nine hospital and they informing loss of blood and other health conditions.  The said information are not within the knowledge and far from truth.  It has denied the fact that : “OP did not diagnose the problem correctly and administered wrong medicines and induction and due to negligence examination on the complaint physically by the doctor at OP’s hospital cause the heavy bleeding which in turn affected the baby in the womb and even after its birth the child was suffering from lack of oxygen as the pipe was separate d from the baby while in the womb and as such even after the complainant discharged from Cloud Nine Hospital after five days the child was to be Hospitalized on more than one occasion for various complications caused due to administration ofo wrong medicine on the complainant because of wrong diagnosis by the OP’s Doctors.”

11.    The entire facts are false, frivolous and the same is not admitted as correct.  In a case of medical negligence, it is to be seen whether the medication and the method of treatment given was proper or not.  Further the bills and amounts spent by the complainant for her unfortunate for extraordinary health issue is not at all the concern with OP and OP has no nexus or relation in the said circumstance.  The complainant has mislead the forum with unnecessary irrelevant information, which is all false, frivolous and self-serving.

12.    The patient visited OP hospital only for symptomatic treatment for abdominal pain and reduction of the abdominal pain which got reduced after proper diagnosis and medication during the COVID circumstances. OP has taken more than sufficient degree of care and caution. complainant did not got the ultra sound scanning which is a proper method of identifying and diagnosing the real problem.  Denying all the other allegations made in each and every para of the complaint and further contended that the last visit of the complainant was on 07.04.2021 on which date doctor prescribed the complainant to undergo ultra sound scanning to be done within 19.05.2021 whereas on 15.05.2021 she visited the hospital for symptomatic treatment for reduction of pain in the abdomen.  The husband of the complainant has threatened the OP and with an intention to extort the ransum money and when failed in his illegal attempt, has filed this complaint, in order to spoil the name and image of the OP hospital and also wanted to cause heavy business loss to the hospital and hence prayed the commission to dismiss the complaint.

13.    In order to prove the case, both parties have filed their affidavit evidence and produced documents. Arguments Heard. The following points arise for our consideration:-

1) Whether the complainant has proved deficiency in service on the part of the Opposite Party?

2) Whether the complainant is entitled to the relief prayed for in the complaint?

14.    Our answers to the above points are:-

POINT NO.1 & 2:        IN THE NEGATIVE

                                      For the following.

REASONS

POINT No.1 & 2:-

15.    On perusing the complaint, version, documents, evidence filed by the both the parties, it becomes clear that, the complainant visited OP for her checkup for pregnancy related matter on 06.02.2021 wherein as per Ex.P1 the gestation period was of 13 weeks. The estimated date of delivery was of 08.08.2021. Again on 15.05.2021, she visited OP’s hospital on the history of severe pain in the abdomen. In the case sheet produced marked as Ex.P3, it is mentioned as ‘Primegravide’, 27^th week, pain in abdomen since morning, vomiting and nousea since morning along with giddiness.  P/A 27^th weeks size, relaxed P/V OS closed informed to Dr.Noor Ul Ayan. It is also mentioned therein that PAN D onset injection, MVI lam taxim and pan was administered. It is also mentioned that the patient felt better since half hour, patient complained of pain abdomen informed doctor, Noor UL Ayan advised “busco pan injection” and USG (ultrasound scan ) upper abdomen plus growth scan.  As per the doctor’s progress note marked as Ex R1, the patient was first seen at 1.30 pm on 15.05.2021.  Wherein, it is also mentioned that PV OS closed no show.  That means there is no bleeding. She was given the medicines as  mentioned above and again at 3 pm it is mentioned that the patient felt better and reduced in pain.  PA UT released. Advised to continue the MVI at 3.25 pm Dr.Bhavana tested again regarding pain in the abdomen and UT relaxed PV OS closed no bleeding, no show, informed the same to Dr.Noor Ul Aiyan regarding the patient condition and advised ‘Busco Pan’ and USG of upper abdomen and growth scan. The patient and the attendant of the patient explained regarding the condition and advised for ultrasound scan. Patient attendant told that they will do the ultra sound scanning and will come back. At 3.45 pm on the same day, the doctors note shows that “Patient attendant informed that they do not want to continue here.” For their further management and they need 2^nd opinion and discussed with Dr.Noor Ul Aiyan and Dr.Azeenz to send the patient for the 2^nd opinion. Hence patient sent from the hospital. 

16.    In the nurses progress report at 1.30 pm on that day, patient was seen by Dr.Bhavana PV done OS closed, no Show, No. PV discharge or leak noted. Again injection was given and medicines was given at 3 pm patient felt better and continued with IV fluid and vitals checked. Again at 3.25 pm pain again informed Dr. Bhavana seen by her and intimated Dr. Noor Ul Aiyan and advised given Busco Pan Injection.  Advised patient to get a scan done as soon as possible and reviewed with the report at 3.45 p.m the patient complained off continuous pain and uncomfortable wants to go for second opinion and scope to Dr.Noor and advised patient to get for scan done for reviewed consultant but patient refused and wanted to go second opinion. So doctor advised to send the patient after LAMA consent. 

17.    It is the specific case of the complainant that the duty doctor after conducting PV test by insulting her finger to test baby 2 or 3 times. She started bleeding and went to Specialist Hospital wherein the doctor examined her.  Ex. P6 is the report of the specialist hospital wherein it is mentioned that “27 week 6 days, single live intra uterine fetus seen in cephalic presentation, Abruptio placenta and Anterior of Grade 1 maturity, with large retroplacental collection measuring 3 X 16 cm. Placenta appears irregular and hyperechoic - Cervix measures 3.8 cms - Liquor volume adequate. No cord around the neck, Doppler: MCA PI-0.8 - Umbilical PI - 0.6 and impression single live intra uterine fetus of about  27 weeks 0 days gestation in cephalic presentation at the time of scan. “Abruptio placenta” growth corresponds to 40^th percentile. This is the scanning report.

18.    Afterwards Dr.Usha who has seen the patient i.e. complainant refers the matter to Cloud Nine Hospital, stating that “respected doctor hereby referring Mr. Anusha Y with 27 week pregnancy with notllear hemorrhage. Unbooked patient. “Betrosol 12 mg injection start.”  Afterwards, the complainant was taken to Cloud nine hospital for treatment wherein according to the averments made in the complaint, she was immediately attended and found that there was lot of blood loss and the baby was separate from the food pipe and immediately undertook operation to took the baby out of the womb and a live baby got delivered” which need oxygen support for which they have to spent Rs.27,57,003/- towards the surgery other charges, medicines, transfusion of blood and for other requirement.

19.    It is the case of the complainant further that since OP did not take care in the hospital, the bleeding started and the baby was separated in the womb from the food pipe and there was massive blood rush in the uterus which was diagnosed as “Placenta Abruptio” which have to be operated immediately otherwise there would have been threat to life of the baby and the mother. Further the careless examination by the duty doctor of OP physically caused heavy bleeding which in turn affected the baby in the womb and even after the birth, the child was lacking oxygen and even after discharge from the Cloud Nine Hospital, the child was to be in the hospital for more than one occasion for various complication, cause due to the administration of wrong medicines and also due to wrong diagnosis.

20.    Except the self-serving statement of the complainant that the test of PV by inserting the fingers by the duty doctor and also administering the medicines as mentioned above, which according to the complainant are not proper, has not been amplified by the complainant.  When the complainant has got the 2^nd opini0on and got the USG scanning done in another hospital, and afterwards when she was referred to cloud nine hospital, wherein the surgery was conducted and the baby was removed from the womb, those expert doctors have not at all been examined before this commission to show to this commission that the line of examination, the way of examination, the medicines given by the OP at the first instance, is not the usual protocol, not the usual method, and some other medicines and method ought to have been practiced by the duty doctor of OP. 

21.    It is no doubt true that the scan report Ex.P6, it was reported “abruptio placenta”. This may happen due to the sudden shock or heavy blow on the abdomen. The doctor who is well versed with the anatomy of the body, and also the physiology of the body, is also experienced, has tested the complainant when she went to the hospital for her subsisting pain in the abdomen.

22.    Both parties have relied on the journals, articles and literatures.  It is mentioned in the said literatures:-

“ANTEPARTUM HEMORRHAGE

Slight vaginal bleeding is common during active labor. This “Bloody show” is the consequence of effacement and dilatation of the cervix with tearing of small veins, Uterine bleeding from a site above the cervix before delivery is cause for concern. The bleeding may be the consequence of some separate of a placenta implanted in the immediate vicinity of the cervical canal – Placenta Previa. It may come from separation of a placenta located elsewhere in the uterine cavity – abruption placentae. Rarely, the bleeding may be the consequence of velamentous insertion of the umbilical cord with rupture and hemorrhage from a fetal blood vessel at the time of rupture of the membranes – vasa previa.

The source of uterine bleeding that originate above the level of the cervix is not always identified.  In that circumstance, the bleeding typically begins with little or no other symptomatology, and then stops, and at delivery no anatomical cause is identified.  Almost always the bleeding must have been the consequence of slight marginal separation of the placenta that did not expand. The pregnancy in which such bleeding occurs remains at increased risk for a poor outcome even though the bleeding soon stops and placenta previa appears to have been excluded by sonography. Lipitz and colleagues (1991) studied 65 consecutive women – almost 1 percent  of their patients – who had uterine bleeding between 14 and 26 weeks. Almost a fourth had placental abruption or previa. Total fetal loss including abortions and perninatal deaths was 32 percent. Even in pregnancies with hemorrhage after 26 weeks that are not explained by placental abruption or previs, Ajayi and colleagues (1992) reported adverse outcomes in a third.  For this reason, delivery should be considered in any woman at term with unexplained vaginal bleeding.

PLACENTAL ABRUPTION. the separation of placenta from its site of implantation before the delivery of the fetus has been variously called placental abruption, abruptio placenta and in Great Britain accidental hemorrhage. The term premature separation of the normally implanted placenta is most descriptive because it differentiates the placenta that separate prematurely but is implanted some distance beyond the cervical internal os.  From one i.e implanted over the cervical internal OS i.e. placenta previa. It is cumbersome, however and hence the shorter turn abruptio placentae or placental abruption has been employed. It is a sudden accident a clinical characteristic of most case of this complication.

Some of the bleeding of placental abruption usually insinuates itself between membranes and uterus and then escapes through the cervix causing external hemorrhage. Less often, the blood does not escape externally but is retained between detached placenta and the uterus leading to concealed hemorrhage. It may be total or partial. Placental abruption with concealed hemorrhage carries with it much greater maternal hazards not only because consumption coagulopathy, but also because the extent of hemorrhage is not appreciated.”

23.    From the above, it becomes clear that the separation of placenta from its site of implantation before the delivery of the fetus has been variously called placental abruption, abruptio placenta and in Great Britain accidental hemorrhage. The term premature separation of the normally implanted placenta is most descriptive because it differentiates the placenta that separate prematurely but is implanted some distance beyond the cervical internal os.  From one i.e implanted over the cervical internal OS i.e. placenta previa. It is cumbersome, however and hence the shorter turn abruptio placentae or placental abruption has been employed. It is a sudden accident a clinical characteristic of most case of this complication. 

24.    It is also mentioned therein some of the bleeding of placental abruption usually insinuates itself between membranes and uterus and then escapes through the cervix causing external hemorrhage. Less often, the blood does not escape externally but is retained between detached placenta and the uterus leading to concealed hemorrhage. It may be total or partial. Placental abruption with concealed hemorrhage carries with it much greater maternal hazards not only because consumption coagulopathy, but also because the extent of hemorrhage is not appreciated. 

25.    The journals and evidence relied on by the complainant do not show that the PV examination can cause placenta abruption. The causes are so many for the same and complainant has failed to prove that due to the physical examination of the complainant by Dr.Bhavana, caused abruptio placenta. Counsel for the complainant has also failed to convince us as to whether there is any alternate method of examining patient for her pain other  than what Dr.Bhavana did, so also that medicines administered to the patient/complainant at that time.

26.    It is to be noted here that the doctors do take care to preserve the life of the mother and the child.  Inspite of taking all precautions and care certain things go beyond their control which we have to hold as the “fate of the patient”. 

27.    Absolutely, in a matter of this nature, more expert evidence is required which is lacking in this case and that the complainant has not at all taken any steps to provide such an expert evidence to pin point as to the physical testing of the complainant by Dr.Bhavana alone caused abruptio placenta. 

28.    It is to be noted here that, the gestation period of the complainant was only 27 weeks 6 days, whereas for the full term the gestation period is about 36 weeks.  When 36 gestation period has reached i.e. (full term) the baby would have grown in the womb properly with all organs getting enough strength to withstand the eventuality when it comes out of the womb. In this case, the complainant developed pain when the gestation period was 27 weeks only which has to be termed as premature delivery during which time the organs have not developed properly to the extent which it ought to have developed. Even the nervous system in the brain, the respiratory system and the lungs would not have developed properly to withstand the intake of the oxygen, for which the baby has to be kept in incubator in NICU and utmost care has to be taken regarding the baby which is a costly affair and the parents has to spend more money for the treatment of the baby.  Absolutely we do not find any negligence or otherwise on the part of the treating doctor and the hospital, though we are having all sympathy to the complainant and to their family. Hence we answer POINT NO.1 & 2 IN THE NEGATIVE and in the result complainant is not entitle for any of the relief prayed in the complaint and  pass the following:

ORDER

1. The complaint is hereby dismissed. No order as to cost.

2. Send a copy of this order to both parties free of cost.

Note: You are hereby directed to take back the extra copies of the Complaints/version, documents and records filed by you within one month from the date of receipt of this order.

(Dictated to the Stenographer over the computer, typed by him, corrected and then pronounced by us in the Open Commission on this day the 20^th day of August 2022)

MEMBER                   MEMBER                  PRESIDENT

ANNEXURES

1. Witness examined on behalf of the Complainant/s by way of affidavit:

Copies of Documents produced on behalf of Complainant/s:

Ex P1: Copy of the prescription issued by Prime Health Care.

Ex P2: Copy of the payment details.

Ex. P3:Copy of the prescription dt:15.05.2021

Ex P4: Copy of the bill

Ex P5: Copy of the reference letter by Specialist Hospital

Ex P6: Copy of the scan report.

Ex P7: Copy of the provisional bill issued by the hospital.

Ex P8: Copy of the final bill.

2. Witness examined on behalf of the Opposite party/s by way of affidavit:

RW-1: Dr.Noor UI Ayain, Doctor of OP hospital.

Copies of Documents produced on behalf of Opposite Party/s

Ex R1: Copy of the Doctors progress notes dt:15.05.2021.

Ex R2: Copy of the Nurses progress notes dt:15.05.2021.

Ex R3: Copy of the Opinion of Dr.Sujini BK

Ex R4: Copy of the relevant portion of the text book of Dr. Williams obstetrics.

MEMBER           MEMBER                  PRESIDENT

RAK*