A Karunanithy vs Padma L Ravindran

THE complainants case is as follows : The second complainant is the daughter of the first complainant. When the second complainant was pregnant, she was examined by the first opposite party, who confirmed the same and directed the 2nd complainant to come for regular periodical checkup. On 4.8.1997 after conducting tests, the first opposite party informed the second complainant that due date of delivery will be on 9.2.1998. She was asked to come once in a week in the 9th month. Accordingly the second complainant went her for checkup. On 9.2.1998, the complainant went to the 2nd opposite party hospital and met the first opposite party, who prescribed Primiprost tablet and directed her to take one tablet in the afternoon, one tablet in the night and another tablet in the next day morning. She was not admitted in the hospital. As advised, the 2nd complainant took one Primiprost tablet around 4.30 p.m. on 9.2.1998. Around 9.30 a.m. she began to vomit, then she immediately contacted the first opposite party over phone. The first opposite party advised her to watch and if pain continues and increases, then admit herself in the 2nd opposite party hospital. The pain continued and gradually increased around 12.00 midnight. The 1st complainant contacted the first opposite party over phone and informed about the pain and vomiting whereupon the

ND complainant was advised to get herself admitted in the 2nd opposite party hospital. The 1st opposite party promised that she would see the 2nd complainant immediately on admission. Accordingly the 2nd complainant admitted at about 12.50 a.m. and the 1st opposite party was informed about the admission. The staff of the 2nd opposite party hospital made preparation seeing the condition of the 2nd complainant to attend the delivery. But the 1st opposite party did not come to the hospital though she instructed through phone the staff to give some injections to reduce the pain. Instead of coming to the hospital and to watch the babys movement in the womb physically and personally, she through the phone prescribed injection to reduce the pain. She avoided to come to the hospital, failed to attend examine the 2nd complainant who was having labour pain from 9.30 p.m. on 9.2.1998. The hospital did not allow the 1st complainant and his son -in -law to stay in the hospital stating that only female members will be allowed. They further informed that the pain and vomiting was due to the tablet taken by her. Therefore, the 1st complainant and his son -in -law left the hospital. The pain did not subside in spite of injection. The 2nd complainant pleaded the hospital staff to contact the 1st opposite party and also requested to do caesarian operation since she was unable to withstand the pain. But the staff refused to contact the 1st opposite party. They also did not allow the mother of the 2nd complainant to contact the doctor. The 1st opposite party came to the hospital around 6.30 a.m. on 10.2.1998 and after examining the 2nd complainant, the 1st opposite party gave Primiprost tablet which the 2nd complainant vomited. Then she was put on drips. Realizing her mistake in not coming to the hospital in the night and on her mistake in not doing caesarian operation, she made preparations to do a caesarian operation and contacted the anaesthetist and a doctor for operation. The 1st opposite party waited for their arrival and went inside the operation theatre. After some time the staff informed the 1st complainant that the delivery was over. When the 1st complainant wanted to see the baby, he was informed that the baby was still in the operation theatre. But the 1st complainant forcefully entered the theatre and saw to his dismay and shock that the new born baby was under oxygen. Without even getting consent of the complainant, the 1st opposite party made arrangements to send the baby to the Child Trust Hospital at Nungambakkam. Only when the ambulance came from the Child Trust Hospital, the complainants came to know about the same. The first opposite party failed to take reasonable care and caution before prescribing Primiprost tablet. She is fully aware that the 2nd complainant is asthmatic and her father had a cardiac asthmatic. She is also aware that before using the tablet, the uterine activity, foetal status, progress of cervical dilation should be carefully monitored. The 1st opposite party ought to have seen that in certain circumstances, it should be avoided with symptoms of pre -existing foetal distress and oral administration of the said tablet will cause vomiting. The 1st opposite party ought to have admitted the 2nd complainant in the hospital and then prescribed the tablet. If she had done that, then she could have closely monitored the 2nd complainant and the baby in the womb. That procedure was not followed. Since the tablet was taken in the house, the after -effects of the said tablet could not be monitored and hence it is resulted that the 2nd complainant started vomiting and it had weakened the patients body and mind as well as the baby in the womb. The 1st opposite party failed to come and see the 2nd complainant in the 2nd opposite party hospital after her admission. Without knowing the history of the tablet she was advised by the 1st opposite party to take the tablet in the night. Because of failure to take the above precautions, the baby consumed meconium which resulted the baby being admitted the Childs Trust Hospital where it died. This all happened because of the first opposite partys wilful negligence, carelessness and indifferent attitude. The 1st opposite party failed to come and see the 2nd complainant. There was no duty doctor in the 2nd opposite party hospital. There were no qualified nurses. Thus, there is deficiency in service which has resulted in the baby swallowing meconium through the mouth and nose and finally died at Childs Trust Hospital on 18.2.1998. Even on 9.2.1998, there was failure to do scan to know about the childs position. The 2nd complainant pleaded with the 1st opposite party that she cannot bear with the labour pain and willing for caesarian operation. They never bothered about her feelings and sufferings. As no anaesthetic doctor was available, the 1st opposite party simply waited for their arrival to do caesarian operation. When they arrived, she tried to operate but since the child had already moved, she used forceps and the baby was brought out in such a condition. The 2nd opposite party hospital is a 24 hours without any duty doctors or qualified nurses. The 1st opposite party was also not present. The 1st opposite party without personally seeing the 2nd complainant directed the 2nd opposite party hospital staff to give voveran injection to stop the labour pain solely because it was midnight and she wanted to avoid coming to hospital. She having given Primiprost tablet on 9.2.1998 to induce the labour pain and prescribed voveran injection to stop the labour pain. The opposite parties were fully aware that meconium went inside the lungs and stomach of the baby. They kept the baby for more than three hours in oxygen and sent the baby to the Childs Trust Hospital with a view to escape from the consequences of their action. There is a failure on the part of the opposite parties to take immediate care and caution. They failed to admit her as soon as he complained of pain. There is failure to do the caesarian operation. There is a failure to take scan. There is negligence in prescribing the Primiprost tablet as a result of this the child died. Apart from that the 2nd complainant was put to severe mental agony and physical strain. Therefore, the complainant pray for a compensation of Rs. 10,56,960 and a cost of Rs. 5,000. 2. The opposite parties have filed a version pleading as follows : The complainants are not consumers. The 2nd complainant consulted the 1st opposite party on 9.2.1998 in her hospital. She examined the 2nd complainant and found her to have clinically normal with adequate liquor. Hence she prescribed Primiprost tablet for priming of cervix so that the induction of labour could be done subsequently. As a precautionary measure, she was also advised to get admitted herself in the hospital if she had pain, draining or bleeding. Hence, the 1st opposite party opined that it was not necessary to admit the 2nd complainant in the hospital at the point of time namely on the forenoon of 9.2.1998. The 2nd complainant contacted the 1st opposite party in the late hours of 9.2.1998 over phone and informed that she had developed pain and immediately she had advised her to be admitted in the hospital of the 2nd opposite party. She was admitted at 1.00 a.m. on 10.2.1998. On admission, the 1st opposite party was contacted by the 2nd hospital staff and the 1st opposite party gave necessary instructions to the duty staff for preparing the 2nd complainant for delivery. As the preliminary preparations were completed for delivery, the 1st opposite party came to the 2nd opposite party hospital on 3.00 a.m. on 10.2.1998 and examined the 2nd complainant and found her just developing labour pains and foetal heart rate was normal. Her general condition was good. Since she was already in labour, the 2nd complainant was advised to walk around and rest in between. The mother of the 2nd complainant was present in the hospital all along with the 2nd complainant. The labour pains were only mild. The 1st opposite party informed the 2nd complainant and her mother that the delivery will be after 7.00 a.m. Her general condition, uterine contraction and foetal heart rate regularly monitored. The allegation that she did not come to the hospital and that she was negligent, lethargic, wilful and deliberte is falsehood. The 1st opposite party did the best for the 2nd complainant. The allegation that the hospital staff did not allow the husband of the 2nd complainant and the 1st complainant to stay in the hospital is because it being an exclusive maternity hospital as there was other pregnant patients the males are not allowed. However, the mother of the 2nd complainant was with her througout. It is not true to say that the 2nd complainant was informed that the pain and vomiting was only due to the taking of tablet. The 1st opposite party visited the hospital at .m. to see the 2nd complainant and again examined her at 5.15. a.m. prior to attending a surgery for another patient by name Mrs. Susheela. At that time, the foetal heart rate was normal. She was again examined by the 1st opposite party at 6.30 a.m. after surgery. The 2nd complainant was having mild contractions. At that time, foetal heart rate was normal and her general condition was good. She was advised to take one Primiprost tablet to augment labour and asked to walk around. This information was conveyed to the 1st complainant and also to the husband of the 2nd complainant. Between 5.30 a.m. and 6..m. on 10.2.1998 the 1st opposite party was engaged in doing fibro -adenoma operation to a patient by name Mrs. Sumithra. It is untrue to say that the 2nd complainant pleaded to the staff no contract the 1st opposite party and requested to do caesarian operation on her. In fact, no such thing happened. It is also not true to say that the staff refused to contact the 1st opposite party. It is also true to say that the 2nd complainant and her mother was not allowed to contact the 1st opposite party. Even at 6.30 a.m. the 2nd complainant was having only a mild contraction and the foetal heart rate was normal. As advised she was given Primpirost to augment labour and was advised to walk around. She took one Primiprost tablet at 6.40 a.m. and she vomited the said tablet. The 1st opposite party was informed about the vomiting of the tablet. She examined the 2nd complainant again at 7.30 a.m. Labour pain was not progressing. Therefore, it was found necessary to start a syntocinon drip for acceleration of labour. Accordingly at 7.30 a.m. syntocinon drip was started and she was monitored by the 1st opposite party and the staff of the hospital. At 8.35 a.m., the 1st opposite party noted variations in foetal heart rate and immediately an artificial rupture of membranes was done at around 8.40 a.m. As meconium staining of liquor was noticed, it was decided to do a caesarian operation in view of the foetal distress as immediate vaginal delivery was not possible. The 2nd complainant was fully conscious and it was conveyed to her and her mother that caesarian operation was to be done. The consent of the mother of the 2nd complainant in the absence of husband and father of the 2nd complainant was obtained and the preparations were made to get the theatre ready for caesarian operation. The paediatrician was called in. On examination of the 2nd complainant at the operation theatre, the 1st opposite party found the conditions favourable for forceps delivery. As forceps delivery under the conditions was faster than the caesarian procedure, the waiting anaesthetist and paediatrician were informed about the development and she applied forceps and delivered the baby. The baby was having the cord around the neck twice. The pediatrician/ neonatologist Dr. Jai Shankar received the baby and resuscitated the child by suction and giving oxygen. At that time, the 1st opposite party was informed by the paediatrician that the child picked up to APGAR 7 within 5 minutes and it was in the best interest of the child that the child to be kept under observation in the childrens hospital. After attending to the 2nd complainant the 1st opposite party called the relatives waiting including the husband of the 2nd complainant and father and mother showed the baby. They were apprised of the need to have expert handling by specialized childrens hospital of which the complainant agreed. Accordingly, the child was shifted to Childs Trust Hospital, Nungambakkam for specialized treatment. The allegation that without even consulting the complainant the arrangement was made is false. It is not true to say that the 1st opposite party failed to take reasonable care. She is an experienced gynaecologist. The decision was taken in respect of the 2nd complainant in the best of interest of the 2nd complainant and the child in the womb. It was taken on sound medical principles and correct medical ethics. The 2nd complainant being asthmatic up 12 years and that her father was a cardiac asthmatic patient and hypertensive had nothing to do with prescribing Primiprost for the 2nd complainant. At the time when the 1st opposite party examined the 2nd complainant she did not show any sign of bronchial spasm. Further the foetal heart rate was normal till 8.35 a.m. There is no negligence on the part of the first opposite party or the hospital staff. From 3 a.m. on 10.2.1998, the 2nd complainant was under caution and careful watch and surveillance of the 1st opposite party. The 1st opposite party was cautious through. She took all necessary precautions. She did all that was best for mother and child. With the permission of the complainants, 2nd complainants mother and husband, the child was sent to Childrens hospital. It is not true to allege that because of the negligence of the opposite parties, the baby consumed meconium. The 2nd opposite party hospital is a 12 bedded hospital having duly qualified and competent and experienced nurses both on night and day duties. The 2nd complainant never informed the 1st opposite party that she could not bear labour pain and she was willing in caesarain operation. The 1st opposite party on examination of the 2nd complainant at around 9 a.m. found the conditions favourable for forceps delivery. The 1st opposite party is residing in a house which is less than 500 metres from the hospital. She has car and it will not take much to reach the hospital from her house. The allegation that the 1st opposite party was trying to avoid to come to the hospital in the night hours is false. The prescription was Primiprost was on sound medical grounds. The 1st opposite party had done everything in the best interest of the mother and the child. To the lawyers notice issued by the complainant, an interim reply had been sent on 18.4.1998, which was followed by a detailed reply. The first complainant came to the opposite parties hospital on 17.2.1998 in the guise of collecting duplicate discharge summary, snatched away the case sheets and ran away. Therefore, the 1st opposite party had to make a criminal complaint and only thereafter they were able to recover the case sheet of the hospital with the help of the police. The 1st opposite party took her MBBS degree from the Madras University in 1980. She took her diploma in Gynaecology and Obstetrics in 1983 from the Madras Medical College and she took her Master Degree in Medicine in obstetrics and gynaecology from Madras Medical College in 1987. She has been honoured by the Parvathy Vasudevan Dedicatory Trust for rendering goods services to the lower middle class people. She was also nominated for Chikitsar Ratan Award. She has five qualified nurses and other hospital assistants. She devotes her entire attention to the patients admitted in the hospital which is recognized by the Indian College of Maternal and Child Health for training in Diploma in Gynaecology and Obstetrics. She had attended to more than 3000 deliveries including normal and caesarian of the deliveries. She has been always prompt and dutiful. The opposite parties, therefore, pray that the complaint be dismissed with costs. 3. The points that arise for determination are -(1) Whether there is deficiency in service as alleged by the complainant? (2) Whether the complainant is entitled to compensation? If so, to what amount?

THE Points : The 2nd complainant rests her case mainly upon two grounds. The first ground of allegation made is that the prescription of Primiprost tablet has brought about this calamity and it was not indicated considering the condition of the 2nd complainant. The next allegation is that immediately on admission of the 2nd complainant in the hospital, the 1st opposite party did not come and examine her. But she took her own time and saw her only at 9.30 a.m. on the next day. It is also stated that when the 2nd complainant reported about pain even on 9.2.1998 in the morning she ought to have been immediately advised to be admitted in the hospital and the 1st opposite party omitted to do so. It is also stated that there were only untrained nurses and staff in the hospital. The request of the 2nd complainant to carry out a caesarian operation for delivery of the child was not listened to by the 1st opposite party and the staff. These are the other allegations upon which this edifice of complaint has been laid.

NOW coming to the general aspect, it is to be pointed out that the complainants have not adduced any expert evidence in support of their case especially when it is contended that the particular drug namely Primiprost ought not to have been administered. Therefore, the failure to examine an expert is really fatal to the case of the 2nd complainant. The first contention that Primiprost tablet ought not to have been prescribed or administered remains merely as a contention. The opposite party has stated in the version that the tablet was prescribed for priming of cervix to facilitate induction of labour. It is asserted by the opposite party that even if the second complainant was asthmatic the administration of such tablet will not have any adverse effect and according to her, when she examined her on 9.2.1998 the second complainant was not suffering from any bronchial spasm. Yet the complainants have not produced any materials in the shape of an expert evidence or medical texts or the brochure relating to the drug to show that the said tablet is likely to have any adverse effect or has a tendency to affect the foetus heart. Even according to the complainant, the 2nd complainant took a Primiprost tablet even on 9.2.1998 morning and evening. There was then no ill effect. According to the complainants, if caesarian operation had been done at 1.30 a.m. when she was admitted, the child could have been saved. In other words, according to them, the childs condition was not bad and the foetal heart rate was sound till 1.30 a.m. on 10.2.1998. It shows that the taking of Primiprost tablet by the 2nd complainant on 9.2.1998 namely two tablets one in the morning and other in the evening on 9.2.1998 had not affected the childs health or the foetal heart till then. Therefore, to say that the Primiprost tablet had something to do with the cause of death of the child cannot be accepted at all. Even according to the 2nd complainant, when she was administered another Primiprost at around 7.30 a.m. on 10.2.1998, she vomited it. Therefore, the contention of the complainant that the administration of or prescription of Primiprost tablet is an act of negligence cannot be accepted at all. The complainants have not produced pharmaceutical literature relating to the product to establish that it has any side effect of that it was contra indicated in cases of this nature. Therefore, that part of the complainants case has not been made out. The second ground of attack of the complainant is that though she was admitted at about 1.00 a.m. in the morning on 10.2.1998 in the 2nd opposite party hospital, the first opposite party did not come and see her immediately, but she took her own time. The opposite parties have produced the case sheet under Ex. B1. It shows that she was admitted on 10.2.1998 at about 1.00 a.m. and the mode of delivery was forceps (sic.) episiotomy. The child weight was 2.75 kg. The case sheet at page 2 contains the following notings: ''Admitted with complaints of labour pain since last night; EDD: 9.2.1998. O/E not anaemic; no oedeur; pulse -80; BP:110/80''. This gives a time as 3.00 a.m. on 10.2.1998. Again, there is another noting at 5.00 a.m. Then there is another noting at 6.30 a.m. and again at 7.15 a.m. At 8.35 a.m. also we find another noting. At 8.40 a.m., it is stated as follows :''Cx well effaced; 5 -6 cm dilated. About 30 ml. of moderate meconium stained. At 9.10 a.m. it is noted as follows : LMC forceps with episiotomy under IV calarpose, LMC AT forceps applied; Application and fraction easy - Delivered a live female baby - cord round the neck twice, thick meconium stained liquor and handed over to pediatrician - placenta expelled entire with membrance... Epi -wound suture.''

THEREFORE , from the entries of the case sheet we find that the doctor has seen the patient at 3.00 a.m., again at 5.00 a.m., again at 6.30 a.m., 7.15 a.m., then 8.35 a.m., 8.40 a.m. and 9.10 a.m. There is also notings at page 2 of the case sheet to the effect that foetal heart rate was good at 1.10. a.m. and then 2.10 a.m., 3 a.m., 4 a.m., 7 a.m. and 7.30 a.m.

IT being maternity hospital, according to the opposite parties, males are not allowed to stay during night hours. It is asserted by the opposite parties that the mother of the 2nd complainant was present throughout with her. Neither the 2nd complainant nor her mother has been examined. As against the allegations made by the complainants, we have the notings in the case sheets which cannot be simply ignored more so when the complainants have not chosen to examine themselves to disprove the same. It is in this connection to be pointed out that the case of the complainants is that the 2nd complainant was having pain and was insisting upon caesarian operation being performed upon her. But the mother who was present with her all through has not chosen to take the witness to speak to the same nor the 2nd complainant has chosen to speak to the same. Even assuming that she had expressed her desire for caesarian operation, it is not incumbent upon the doctor to immediately do it. The doctor, who is in charge of the patient, is the best judge in the circumstances. It is for her to say to decide whether caesarian had to be performed or not. The condition of the patient has to be taken into account. The urgency of the situation has to be taken into account. Therefore, the doctor is the best person to judge when to perform the surgery and when not to perform the surgery. Simply because of the 2nd complainant insisted that the casesarian operation has to be performed upon her, assuming it to be true that the 1st opposite party did not listen to it, still from that it does not follow that there is any negligence. The doctor normally would opt for a natural and normal delivery, which is the best for both the mother and child. According to the complainants, administration of primiprost tablet and the failure to do caesarian operation at the earliest have brought about the death of the child. We have already pointed out that the contention that the Primiprost tablet has brought about the condition or had something to do with the slowing of the foetal heart rate cannot be accepted at all. Similarly it cannot be also accepted that the death of the child was because of the first opposite party refusing to perform caesarian operation immediately at the time of the admission. For, from the case sheet we find that the foetal heart was found to be normal and sound till 7.30 a.m. Therefore, the failure to perform the operation immediately at the time of admission namely at 1.30 a.m. or 3.00 a.m. cannot be cited as a reason for the death of the child.

THE death of the child has been caused by meconium aspiration. According to the Manual of Neonatal Care edited by John P. Cloherty, M.D., and Ann R. Startk, M.D., Harvard Medical School and published by Lippincott -Raven, New York, Meconium -stained amniotic fluid complicates delivery in approximately 9 to 15% of live births. Infants born with meconium stained amniotic fluid frequently have had antepartum or intra -partum asphyxia. Infants born through meconium -stained amniotic fluid had Apgar scores lower than 6 at 1 minute and 19% had Apgar scores at 6 of 5 minutes. Yellow meconium is usually old, while green meconium suggests a more recent insult. If the amniotic fluid is meconium -stained, about half the infants will have meconium in their tracheas. Meconium can be present in the trachea without any evidence of meconium in the mouth or larynx. The amount and thickness of meconium appears to be directly related to the severity of the respiratory symptoms and signs.

IN this case on hand, we find that when the child was delivered by LMC forceps with episiotomy, umbilical cord was found around the neck of the child twice and there was thick meconium stained liquor. The notes further read as follows : ''Thick meconium smearing the baby and aspiration was done and the baby was put on Oxygen.'' It is also to be pointed that at the time of delivery, the Neonatologist Dr. Jaishankar was present. He received the baby and resuscitated the baby by suction and giving Oxygen. The paediatrician had told the first opposite party that the child picked up to Apgar 7 within 5 minutes. Therefore, according to the 1st opposite party, considering the condition of the baby since it required more intensive care, they contacted the Childs Trust Hospital at Nungambakkam and the child was taken to the Childs Trust Hospital for specialized treatment. The complainants admit that immediately on admission at 1.00 a.m. on 10.2.1998, necessary preparations were made for effecting delivery. The 1st opposite party visited the hospital at 3.00 a.m. She found the patient just developing labour pains. She gave certain instructions to the patient as she had to perform some other surgery, she left the patient and came back again at 6 Oclock. Labour pains were mild even at about 7.00 a.m. The foetal heart rate was also monitored. It was at about 8.30 a.m., they found the labour pains were not progressive, syntocinon drip was started. Variation in the foetal heart rate was noted at about 8.35 a.m. and meconium stained liquor was noticed. Therefore, at that point of time, the first opposite party decided to do the caesarian operation. Then when she was taken to the theatre found that her condition was such that the delivery by forceps can be effected, more quickly and accordingly forceps delivery was done and the baby was found having the cord around the neck twice. In the best interest of the child as specialized treatment was necessary in such cases, the baby was later sent for further care to Childs Trust Hospital at Nugambakkam. These developments find support in the case sheet produced by the opposite parties. There is no suggestion or attack against the notes of the case sheet. It is neither contended nor can be contended that the case sheet has been fabricated for the purpose of the case. Here in this case what we find that the labour pain was not progressive and the contractions were only mild. To accelerate labour, syntocinon drip was given. This did not bring about any favourable reaction in the patient. At about 8.30 a.m., there was meconium -staining. Further at that point of time, there was variation in the foetal heart rate. Therefore, apparently, the baby in the womb had consumed meconium and thus the complications had arisen. The baby in the womb consuming meconium was not anticipated. At the same time, we find from the authorities that the meconium aspiration which can result in acute or chronic hypoxia and meconium stained amniotic fluid complicates delivery in about 9 to 15% of live births. This complication namely passage of meconium in utero rarely occurs prior to 37 weeks gestation but may occur in more than 30% of pregnancies that continue past 42 weeks gestation. It is seen from the medical text books that Foetal Aspiration Syndrome Aspiration Pneumonia occurs during prolonged labours (Here the labour was prolonged) and difficult deliveries where infants often initiate vigorous respiratory movements in utero because of interference with the supply of oxygen through the placenta. Under such circumstances, the infants may aspirate amniotic fluid containing vernix caseosa, epithelial cells, meconium, or material from the birth canal which may block the smallest airways and interfere with alveolar exchange of oxygen and carbon dioxide. According to the Textbooks of Paediatrics by Richard E. Behrman, MD, 16th Edition, published by Harcourt Asia Pvt. Ltd., A Harcourt Publishing International Company, Meconium -stained amniotic fluid is found in 5 -15% of births and usually occurs in term or post term infants. Five per cent of such infants develop meconium aspiration pneumonia; 30% of these require mechanical ventilation and less than 5 -15% expire. Usually but not invariably, foetal distress and hypoxia occur with passage of meconium into the amniotic fluid. These infants are meconium stained and may be depressed and require resuscitation at birth.

IN this case on hand, it is what has happened and it has brought about the foetal distress and ultimately the death of the infant. Therefore, the death of the infant in this case cannot be held to be the direct act of any commission or omission on the part of the opposite parties. The 2nd complainant had prolonged mild labour. Her contraction was not to the level necessary. The attempts to induce labour by administration of syntocinon drips and Primiprost were not successful. Nearly after 12 hours after she developed pain at about 8.30 a.m. on 10.2.1998, there was meconium stained noted by the doctor who, therefore, decided to carry out caesarian operation, but found the condition to be favourable for forceps delivery and accordingly delivered a live female child. It had the cord around its neck twice. It had consumed meconium and, therefore, it had to be resuscitated and the paediatrician informed at that time that the child picked up Apgar 7 within 5 minutes. Considering the condition of the child as specialized treatment was found necessary to deal with the child, the baby had been shifted to a specialized hospital for children. Therefore, it is impossible to hold that the death of the child or the meconium staining was in any manner attributable to any act of negligence or deficiency in service on the part of the opposite parties.

IT is also to be pointed out that the child, which was admitted in the Childs Trust Hospital did not die immediately, but died on 18.2.1998. It means that the child had lived or had been alive for more than a week after delivery. The child suffered from meconium aspiration syntocinon/bilateral pneumothorax/PPHN/ hypocalcemia/asymptomatic anaemia/cardiac arrest. In cases where there is utero meconium consumption during the course of delivery, the usual method to clear the airways with suction, administration of oxygen and generally respiratory support. The clearing of airways or suction or administration of oxygen had been done by the opposite parties. For the purpose of general respiratory and specialized treatment in that regard, the child was sent to the Childs Trust Hospital. From an analysis of above facts, it will be clear that the first opposite party has exercised necessary expertise and skill in the treatment of the 2nd complainant. The complication had arisen not because of any deficiency in service but because of inherent that accompanied a delivery. Meconium is the first intenstinal discharge of a new born infant which will be greenish in colour and consisting of epithelial cells, mucus and bile. Meconium aspiration results from the intrauterine aspiration by the foetus of amniotic fluid contaminated by meconium, which causes obstruction of airways and interfere with the respiratory process. From the textbooks we find that Apgar score is adopted for evaluation of a new born infants physical status by assigning numerical values to each of 5 criteria. The criteria consist of heart rate, respiratory effort, muscle tone, response stimulation and skin colour. A score of 8 -10 Apgar indicates the best possible condition while score at 7 within 5 minutes is not indicative of anything untoward. Here it picked up Apgar upto 7 within five minutes. Therefore, whatever duty that has been cast upon the doctor has been performed by the 1st opposite party with due diligence and care. The contention of the complainants, therefore, cannot be accepted at all.

IN fine, we have to hold that there is no material whatever to find the first opposite party guilty of any deficiency in service or negligence in treatment of the 2nd complainant. Whatever that happened had happened not on account of the absence of care by the opposite parties but it is inevitable complication and risk inhering a mother giving birth to a child. Hence we hold that there is no deficiency in service and consequently the complainant is not entitled to any damages or compensation.

IN the result, this complaint is dismissed but in the circumstances without costs. Complaint dismissed. - ===========================================================================