DATE OF FILING : 4.1.2016
IN THE CONSUMER DISPUTES REDRESSAL FORUM, IDUKKI
Dated this the 30th day of May, 2017
Present :
SRI. S. GOPAKUMAR PRESIDENT
SRI. BENNY. K. MEMBER
CC NO.6/2016
Between
Complainants : 1. Manoj, S/o. Mathew,
Thakidiyel House,
Alpara P.O.,
Kanjikkuzhi, Idukki.
2. Josmy Manoj, W/o. Manoj,
Thakidiyel House,
Alpara P.O.,
Kanjikkuzhi, Idukki.
(Both by Adv: Shiji Joseph)
And
Opposite Parties : 1. Archana Hospital,
Thodupuzha.
Represented by
Managing Partner/Proprietor.
2. Dr. R.P. Mythreyi, MBBS, DGO,
Consultant Gynaecologist,
Archana Hospital,
Thodupuzha.
(Both by Adv: Sijimon K. Augustine)
O R D E R
SRI. BENNY K. (MEMBER)
Complainants are husband and wife. The second complainant was pregnant and had been under the treatment of the gynaecologist in Medical College, Idukki. Since the first and second deliveries were caesarian , the complainants were told that the third delivery would be a caesarian. At that time, the operation theatre of Idukki Medical College was closed for renovation and hence second complainant was referred to a higher centre. Complainant was admitted in the second opposite party hospital on 10.7.2015 and caesarian was done on 15.7.2015. First complainant
(cont.....2)
- 2 -
signed the consent form for caesarian and had gone out to get some clothes and oil for baby as per the instruction of a nurse from the opposite party. Complainant delivered a male baby through caesarian at 1.25 pm. But without getting the consent of the first complainant, 2nd opposite party had done the sterilization. Consent of 2nd complainant was taken while she was undergone caesarian. Opposite party forced the complainant for sterilization stating another caesarian would be dangerous to her life. Complainants stated that sterilization done at a very young age would course serious health problems, like weight growing, BP, hormonal imbalance, emotional stress etc. The reasons stated by opposite party for sterilization without the consent of the complainant do not reveal any emergency which warrants immediate sterilization. The act of the opposite party is a gross deficiency from the part of opposite party which is to be compensated.
First and 2nd opposite parties filed detailed version and admitted that the 2nd complainant was admitted in opposite party’s hospital with indications of pre-mature uterine contractions on 22.6.2015 and had given treatment to avoid premature delivery and got discharged on request on 25.6.2015. Again on 10.7.2015, 2nd complainant was admitted with complaints of pain abdomen and properly watched and could not prolong the delivery, as the stage was premature in view of EDC (Expected Date of Confinement), 2nd opposite party informed the complainants that trial labour was not at all possible or advisable because contra indications like previous caesarian, gestational diabetes and PIH (Pregnancy Induced Hypertension) and explained about the risks and complications. Fully aware of the risk conditions, 1st complainant had voluntarily had given written consent. The 2nd complainant had informed 2nd opposite party about their desire to conduct sterilization along with caesarian, due to general health condition and poor economic condition to maintain a fourth child. 2nd opposite party also recommended sterilization since after three
(cont.....3)
- 3 -
consecutive caesarian operations within a short time span, another pregnancy would have adverse effect on health, because of GDM, PIH and especially thinning of uterine lower segment. 2nd complainant voluntarily signed consent form for sterilization on 15.7.2015. 1st complainant was not available then and his signature could not be obtained. 2nd complainant delivered a male baby by caesarian section at 1.26 pm on 15.7.2015.
Intra operatively there was distorted anatomy evidenced by intra peritoneal adhesions and thereby urinary bladder was densely adherent to uterine scar which was very much thinned out to an extent that the baby's hair could be seen through the extremely thinned out uterus lower segment. The second opposite party had confronted with difficulty in suturing the papery thin edges of the uterine lower segment. In such a condition it was explained to the patient on the spot and she stick on her decision to undergo sterilisation. The condition was conveyed to the relatives and they had also agreed to the 2nd complainant's decision but unfortunately the 1st complainant was not available to get his written consent. Since the consent was reaffirmed by the patient and her other relatives on the spot, the 2nd opposite party had proceeded with sterilisation and conducted bilateral tubal ligation adopting modified Pomeroy's technique in utmost good faith and with good intention for the benefit of the patient.
After caesarian and sterilization, the matter was discussed with 1st complainant, but he had raised no protest regarding the same and fully supported the 2nd complainant’s decision. 2nd complainant was discharged on 7th post operative day. Discharge summary with details of surgery and facts of tubal ligation done with written consent of the complainant was issued, sterilization operation conducted with modified pomeroy’s method
(cont.....4)
- 4 -
is the medically accepted device and the same will not cause any health problem.
The allegation that 2nd opposite party had not revealed any complications, warranting sterilization operation is denied. In fact sterilization was done not to for avoiding any intra operative complications but for preventing future pregnancy which result in more complications which would endanger the life of the mother and foetus. 2nd opposite party had acted with good intention for the benefit of the 2nd complainant. There was no professional misconduct or deficiency in service from the 2nd opposite party in conducting the sterilization operation. 2nd opposite party had treated the 2nd complainant with due diligence and care as per standard procedure and accepted protocol, keeping utmost transparency in treatment procedure and disclosing the findings and treatment details to the patient and her relatives. Opposite parties are not liable to compensate the complainants. Hence the petition may be dismissed.
The point for consideration is whether there is any deficiency in service from the part of opposite parties, and if so, for what relief the complainant is entitled to ?
Oral and documentary evidence adduced by complainant and Exts.P1 and P2 marked. Exts.R1 and R2 marked from the side of opposite parties.
The POINT :- Second complainant is examined as PW1. 1st complainant is the husband of the 2nd complainant. Complainants are aggrieved since 2nd opposite party had done sterilization operation along with the 3rd caesarian operation of the 2nd complainant without the consent of her husband who is the 1st complainant. The 2nd complainant stated that sterilization operation will lead to serious health and emotional problems, hormonal imbalance etc. Copy of discharge summary marked as Ext.P1. Discharge certificate copy is marked as Ext.P2. (cont.....5)
- 5 -
Opposite parties in their detailed written version, stated that 2nd complainant had undergone caesarian section in 1st opposite party’s hospital by 2nd opposite party. 2nd opposite party stated that the complainant when admitted in their hospital for her 3rd delivery with a history of two previous caesarian operations done within a short span. Here EDC was on 12.8.2015 and had GDM and PIH. Here pregnancy was considered a high risk and in treatment, 2nd opposite party had taken due precautions as per protocol. She was admitted on 22.6.2015 with a history of premature uterine contractions, after treatment, discharged on 25.6.2015. Again she was admitted on 10.7.2015 with complaints of pain abdomen. Complainants were informed about risks of a trial labour, with their written consent, caesarian was posted and she delivered a male baby at 1.26 pm on 15.7.2015. Intra operatively there was distorted anatomy evidenced by intraperitoneal adhesions, thereby urinary bladder was densly adherent to uterine sear, which was too thinned out that even baby’s hair was visible through the extremely thinned out uterus lower segment. 2nd opposite party had difficulty in suturing the papery thin edges of the uterine lower segment. The risk in bearing another child was explained to the 2nd complainant on the sport and conveyed to the relatives outside. 2nd complainant and relatives agreed for sterilization and the 2nd complainant signed the consent form. 1st complainant was not signed the consent form. 1st complainant was not there and his signature could be obtained. Later, the details regarding the post operative findings and sterilization were discussed with the 1st complainant and no protest was raised. When the patient was discharged on the 7th post operative day, discharge summary and sterilization details were also given and then also no protest was raised. Moreover, the procedure was done as per the written consent of 1st complainant. Ext.R1 is the consent form signed by the complainant. Ext.R2 is copy of standards for female and male sterilization services.
(cont.....6)
- 6 -
We have carefully gone through the deposition of PW1 and verified the records filed by both the parties. On cross examination, the 2nd complainant, who had undergone treatment, specifically admitted that there was no negligence from the part of opposite party in the treatment and service extended to her. Moreover, she signed the consent form for conducting sterilisation with full knowledge and she was conscious at that time. She deposed that, “Ext.R1 apdnbn sh¨v kzta[bm H¸n«XmsW¶p ]dbp¶p.(Q) apdnbn sh¨v H¸n«p sImSp¯ncp¶p.(A) Sterilisation \S¯m³ F\n¡v k½Xambncp¶p. F\n¡v k½XambXpsImWvSmWv Ext.R1þ H¸n«Xv.(page 3 of deposition). Xm¦fpsS Bhiy{]ImcamWv 2nd opposite party sterilisation \S¯nbsX¶p ]dbp¶p(Q). F\n¡v k½Xambncp¶p(A) (page 4). In re-examination also she admitted that, she had signed Ext.R1 before administrating anaesthesia. At this juncture it is very pertinent to go through Ext.R2. Direction issued by the Government of India, Division of Research Studies and Standards, Ministry of Health and Family Welfare, in Standards for Female and Male Sterilisation Services. In page 16, clause 1.4.4 of the condition stated as,
Consent for sterilisation operation should not be obtained under coercion or when the client is under sedation.
Client must sign the consent form for sterilisation before the surgery.
The consent of the spouse is not required for sterilisation.
In this case, the consent is given by the 2nd complainant and signed the consent letter with full conscious and after realising its importance and after fully convincing. No contra evidence is produced by the complainant to rebut the version of the opposite party.
As stated in para 6 of the complaint, the complainant failed to produce any expert opinion to strengthen his allegation that the sterilisation would cause serious health problems like weight gaining, blood pressure, hormonal imbalance and emotional stress etc. Moreover, it
(cont.....7)
- 7 -
is also to be noted that, in this case sterilisation was done on 15.7.2015 and complainant approached this Forum only on 19.12.2015, that is, after a long delay of 5 months. If it is a professional misconduct and deficiency in service from the part of 1st opposite party, what prevented the complainant to proceed against the opposite parties forthwith, since they are aware of this sterilisation operation on the same day itself.
Here the version of opposite parties are believable to the extend that, the complainants had male and female children alive and the 2nd complainant was admitted for third delivery, she had informed the 2nd opposite party that they were desirous to conduct sterilisation along with caesarian inter alia, due to general health problems and the 2nd opposite party had also recommended sterilisation since after three consecutive caesarian operations within short span, another pregnancy would have adverse effect on her health condition especially because of gestational diabetes and Pregnancy Induced Hypertension and above all the possibility of thinning of uterine lower segment.
Therefore, we are of a considered view that the 2nd opposite party doctor have performed her duty reasonably and there was no direction of standard of medical treatment for the consent of spouse and the sterilisation operation was done with full consent of the 2nd complainant and only for their bright future and no deficiency in service or professional misconduct from the part of opposite party is established by the complainant with plausible evidence.
Hence the complaint dismissed. No cost or compensation is ordered.
Pronounced in the Open Forum on this the 30th day of May, 2017
Sd/-
SRI. S. GOPAKUMAR, PRESIDENT
Sd/-
SRI. BENNY. K., MEMBER (cont.....7)
- 7 -
APPENDIX
Depositions :
On the side of the Complainant :
PW1 - Josmy Manoj
On the side of the Opposite Party :
Nil.
Exhibits :
On the side of the Complainant :
Ext.P1 - Copy of discharge summary
Ext.P2 - Discharge certificate copy.
On the side of the Opposite Party :
Ext.R1 - consent form signed by the complainant.
Ext.R2 - copy of standards for female and male sterilization services.
/ Forwarded by Order /
SENIOR SUPERINTENDENT
