ANUPAM JAIN vs UMAKANT PANDEY

-THESE two appeals arise out of the order dated 29.4.2003 in Case No. 242/1997 passed by the District Consumer Disputes Redressal Forum, Rewa.

THE facts of the case in brief are that complainant Umakant Pandey filed a complaint before the District Forum alleging medical negligence against the appellant-opposite party-Doctors, in the treatment of his wife deceased Smt. Chandrakanta. It is admitted fact that Smt. Chandrakanta was pregnant, therefore, she was brought to the Nursing Home of the appellant on 19.12.1996 at 2.30 a.m. She was admitted in the hospital, labour pain continued upto 11.00 a.m. then it was found that there was some complications in the delivery. THE appellant took her in the operation theatre and by using Forceps performed delivery at about 1.00 p.m.on 19.12.1996. THE delivery was successful and the patient was shifted to the ward. At about 1.30 p.m. the patient Smt. Chandrakanta felt uneasiness. THE complainant informed the Doctors who attended her and found that her condition was serious having feeble pulse and chest discomfort. THE Doctors tried to control the patient but at 2.05 p.m. the patient Smt. Chandrakanta expired. THE complainant respondent has alleged that the opposite party Dr. Anupam Jain has acted negligently and pointed out the following two deficiencies committed by him : (1) While using forceps in delivery the head of the new born child was injured because of mis-handing of the forceps. (2) THE opposite party - doctor should have attempted to caesarean method of delivery rather than using forceps.

The District Forum after appreciation of the evidence gave a finding that the opposite party appellant should have attempted checking the embolism so it does not reach the heart where it blocked the circulation of blood and consequently caused pulmonary emoblism which ultimately resulted death. Therefore, found the appellant responsible for committing medical negligence. The Forum awarded compensation of Rs. 1,20,000/- with 9 per cent annual interest from the date of filing of the complaint i.e., 29.4.2003 with costs of Rs. 1,000/-. It is against this order that the appellant has preferred this appeal. Appeal No. 843/2003 has been preferred by opposite party No. 1 - Dr. Anupam Jain, who has submitted that he has acted according to the norms of medical ethics and is, therefore, not guilty for committing any negligence.

Appeal No. 1037/2003 has been preferred by the opposite party No. 4 - National Insurance Company on the ground that the District Forum has discharged opposite party Nos. 2 and 3 and have held Dr. Anupam Jain and the Insurance Company responsible for paying the compensation while, the complainant has stated that the opposite party Nos. 2 and 3, Dr. Shashi Jain and Dr. S.P. Jain were also associated in the delivery process. The District Forum should have not restricted the payments of compensation only to be paid by opposite party Nos. 1 and 4, therefore, order of the District Forum should be quashed.

WE have gone through the evidence on record and the order of the District Forum. Our finding on the allegation of the complaint is as follows : So far as the first allegation, that while using forceps in delivery the head of the new born child was injured because of mishandling of the forceps is concerned, a perusal of the case sheet of the hospital record reveals that the appellant has not resorted to a operation either caesarean or any other kind. The papers reveal that the deceased Smt. Chandrakanta was admitted in the hospital on 19.12.1996 at 2.30 a.m. The labour pain contiuned till 10 a.m. i.e., for 8 hours and when there was unusual situation that the head of the child was not coming out then a decision to use forceps was taken and about 10 a.m. a male child was delivered. In the medical science use of the forceps is an approved method of delivery, in which situation a caesarean operation is avoided. In "Manual of Clinical Problems is Obstetrics and Gynaecology, Fifth Edition", by Michel E. Rivlin & Rick W. Martin at page 161 it is mentioned that "for almost ever obstetrician has been in a situation where fatal distress is present and caesarian delivery is not immediately possible. A skilful forceps delivery in this senario can be life saving." This book prescribes the following methods of delivery : (a) Use of forceps (b) Method of vacuum extraction (c) Caesarean.

This medical literature makes clear that to avoid caesarean operation forceps can be used. This book further reveals that a large study conducted by the Collaborative Perinatal Project involving approximately 30,000/- babies, all undergoing periodic examinations for upto 4 years, failed to reveal any evidence that forceps operations increased the hazard of neonatal death or were associated with subsequent neurologic impairment of the neonates. This supports the argument of the appellant that he took a decision to perform a delivery by use of forceps by avoiding the caesarean operation, and we find that if he had chosen a method which is approved in the medical science the appellant cannot be held medically negligent.

SO far the allegations that the use of forceps has resulted injury on the head of the new born baby is concerned Dr. A.S. Pant in his evidence has stated that there was abrasion on the forehead of the child which were sutured to avoid further bleeding and infection. There was no problem to the newly born child. Coming up abrasion on the head of a newly born child is a usual thing and in the present case there was no harm to the child by the use of the forceps. This evidence leads to the conclusion that the appellant had taken a decision to perform delivery by use of forceps and the use of forceps was successfully done which has not caused any harm to the newly born child, therefore, this allegation of negligence is baseless. Here we mention that the Hon''ble Supreme Court has observed in the case of treatment adopted by a doctor that there are several courses of treatment and if a doctor adopts a particular course of treatment then he cannot be held to be negligent in any way. Here we find that the appellant had chosen a system of forceps delivery to avoid caesarean operation and, therefore, cannot be said to have committed any negligence. We quote : "A medical practitioner has various duties towards his patient and he must act with a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. This is the least which a patient expects from a doctor. The skill of medical practitioners differs from doctor to doctor. The very nature of the profession is such that there may be more than one course of treatment which may be advisable for treating a patient. Courts would indeed be slow in attributing negligence on the part of a doctor if he has performed his duties to the best of his ability and with due care and caution. Medical opinion may differ with regard to the course of action to be taken by a doctor treating a patient, but as long as a doctor acts in a manner which is acceptable to the medical profession and the Court finds that he has attended on the patient with due care, skill and diligence and if the patient still does not survive or suffer a permanent ailment, it would be difficult to hold the doctor to be guilty of negligence."

Therefore, the complainant is wrong in suggesting that the opposite party - Doctor should have adopted caesarean method of delivery rather than using forceps. Now, we come to the situation which resulted in the death of the deceased Smt. Chandrakanta. As has been made clear that during delivery no caesarean operation was performed, therefore, there was no question of cutting or disturbing any artery or vein of the deceased patient. There is evidence of Dr. S.C. Sexena, who is a retired Prof. of Gynaecology of Medical College, Rewa. He has stated that after going through the case history of the deceased Smt. Chandrakanta he is of the opinion that the death is caused by Pulmonary embolism. This is caused if blood clot reaches lungs, through heart which causes sudden death of any person. The medical book "Progress in Obstetrics and Gynaecology edited by John Studd" at page 61 mentions that caesarean delivery carries an increase risk of fatal thrombo embolism as compared to the vaginal delivery and further it says that : "Passage of the fetal head through the birth canal inevitably causes trauma to the pelvic veins. This trauma is increased in operative delivery, whether abdominal or vaginal. Thus, all aspects of Virchow''s triad, hypercoagulability, venous stasis and vascular damage come together in the course of normal pregnancy and delivery, so setting the scene for Venous Thrombo - Embolism." Another book "Manual of Clinical Problems in Obstetrics and Gynaecology" by Michel E. Rivlin & Rick W. Martin at page 199 mentions that : "Deep venous thrombosis (DVT) is an uncommon but serious complication of pregnancy because of the ultimate risk of pulmonary embolism (PE) and potential fatal outcome. The incidence of DVT during pregnancy ranges from 0.5 to 3 per 1,000 (a fivefold increase from the non-pregnant state). It appears that the frequency of venous thromboembolism increases with advancing gestation, with an equal occurrence between the antepartum and postpartum periods. If untreated, there is an 16% - 24% mortality rates. If adequately treated, however, PE occurs in less than 5% with a mortality rate of less than 1%.

THE above medical literature makes clear that the pulmonary embolism is a medical complication which occurs in delivery cases. THE veins are inside the body and it is very difficult to locate the clot inside the veins and, therefore, to allege that the Doctor has not made efforts to check the emobolism is not justified. THE District Forum only on this count has held the appellant responsible for medical negligence that he has not made efforts to check the clotting and the consequence leading to pulmonary embolism. We do not agree with this finding.

TO conclude, we find that the appellant-Dr. Anupam Jain has followed the recognised procedure for delivery by using forceps and as a doctor of general prudence he has tried to attend the patient - deceased Smt. Chandrakanta and, therefore, we do not find that he has committed any medical negligence. The findings recorded by the District Forum are errneous and are not sustainable. This apepal is, therefore, allowed and the order of the District Forum is set aside. In view of our finding above, Appeal No. 1037/2002 filed by the Insurance Company is rendered infructuous and disposed of accordingly. Consequently, the complaint of the respondent is also dismissed. The parties to bear their own costs. Appeal allowed.