Ashok B. Patel vs Mansuri Kasambhai Fakir Mohammed

THE present Revision Petition has been filed before this Commission under Section 21(b) of the Consumer Protection Act, 1986 against the impugned order dated 15.5.2008 in Appeal No. 1131 of 2006 passed by the State Consumer Disputes Redressal Commission (in short, ''State Commission''). The State Commission dismissed the Appeal filed against the order in Complaint No. 102 of 2001 dated 13.10.2006 passed by the District Consumer Disputes Redressal Forum, (in short, ''District Forum''). This is a case pertaining to allegations against a Gynaecologist, who was found to be negligent in taking care of the patient/Complainant, during pregnancy and during the post -delivery period. Smt. Sahidaban, wife of the Complainant, Mr. Mansuri Kasambhai Fakir Mohammed was pregnant under the supervision of Dr. Ashok B. Patel (the OP -1). On 1.10.2000 she started getting pains and was admitted to Mamta Gynec Hospital of OP -1. In the morning around 6.00 a.m. a male baby was born, thereafter, the OP -1 left for his home. The patient started bleeding; OP -1 did not take proper care after the delivery. The compounder in the hospital told her that there was nothing to worry; he called the OP -1, who came after 1 hour. After examination, the OP -1 advised for immediate operation for removal of uterus (hysterectomy). Blood was not arranged. OP -1 removed the uterus, but bleeding continued. The OP -1 informed the Complainant to arrange 4 -5 units of blood and asked the Complainant to shift the patient to Ahmedabad Civil Hospital. Unfortunately, the patient died, on the way to Ahmedabad Civil Hospital. The post -mortem was performed at Civil Hospital, Ahmedabad, which revealed that the patient was anemic because of profuse bleeding. Hence, due to deficiency of service and lack of proper care, OP was negligent. The Complainant filed a complaint before the District Forum.

THE District Forum allowed the Complaint and directed the OP to pay Rs. 2,42,000 with 6% rate of interest and also awarded Rs. 1,000 as costs. Against the order of the District Forum, OP preferred an appeal before the State Commission, which was dismissed. Against the order of the State Commission, OP filed a Revision Petition before this Commission.

WE have heard the Counsel for both the parties. The Counsel for the Complainant vehemently argued that, the patient developed post -delivery PPH. It was Atonic Post -Partum Haemorrhages (PPH) and there was excessive bleeding. Hence, the choice of treatment was to perform hysterectomy on the patient. He further argued that prior to operation, the OP had informed the complainant to arrange for 4 to 5 units of A negative blood. Due to lack of blood, OP -1 decided to shift the patient to Civil Hospital, Ahmedabad. Hence, there was no negligence or lack of care on behalf of OP. The Counsel for the Complainant argued that the OP should have informed about the need of blood, prior to delivery or during the Antenatal visits. It was a rare blood group and hence was difficult to arrange donors of that Group, at eleventh hour. Therefore, OP was negligent in treating the patient.

WE have perused the reply filed by the OP before the District Forum. The District Forum made its observations that, the OP has not produced any documents to show that he has not accepted fees, not produced any medical records. We have noted that, it was a normal delivery without any complications. Thereafter, she started bleeding but OP failed to clarify, that why it has occurred, why bleeding was not stopped? This was an act of omission, hence it''s negligence. In the case of Poottam Vertna v. Ashwin Patel, : II (1996) CPJ 1 (SC) : (1996) 4 SCC 332, where the question of medical negligence was considered in the context of treatment of a patient, it was observed as under: "42. Negligence has many manifestations - -it may be active negligence, collateral negligence, comparative negligence, concurrent negligence, continued negligence, criminal negligence, gross negligence, hazardous negligence, active and passive negligence, willful or reckless negligence or negligence per se...."

We are of considered view that, it is a continued negligence because, the patient was under observation/treatment of OP -1, prior to delivery and she was A -Rh Negative, which is a rare blood group. OP failed to anticipate or to caution the patient or her relatives about the need of blood in an unexpected emergency. Further, after delivery, the patient developed haemorrhages (bleeding -PPH) for which OP -1 has neither properly investigated nor treated to stop bleeding. The OP performed hysterectomy, but the bleeding continued and unfortunately the patient died. Those entire events are due to negligence of OP -1.

WE have gone through the medical text books like William Obstetrics and got information on PPH. Post -partum Haemorrhage (PPH) is an obstetrical emergency that can follow vaginal or cesarean delivery. It is a major cause of maternal morbidity, and one of the top three causes of maternal mortality. The causes of PPH can be broadly classified into problems with uterine tone (atony), retained placenta, trauma (of the lower genital tract and uterus), and coagulation problems, which may be preexisting or acquired as a result of other pathology (such as disseminated intravascular coagulation). If the birth was assisted with forceps or vacuum extraction, the likelihood of trauma will be higher. Alternatively, if labour was prolonged, uterine atony may be more likely. The care pathways suggest starting with the more effective, less invasive and less costly measures and, if those fail to stop the bleeding, moving towards invasive and more costly methods that require expertise and specific facilities. The cornerstones of resuscitation during PPH are restoration of both blood volume and oxygen -carrying capacity. Obstetricians should draw on the expertise of their colleagues in anaesthesia; haematology and transfusion medicine in determining the most appropriate combination of intravenous clear fluids, blood and blood products for continuing resuscitation. Volume replacement must be undertaken on the basis that blood loss is often grossly underestimated.

On the basis of medical literature, evidence on record and due to concurrent findings we conclude that, the order of State Commission is well reasoned, which does not warrant our interference. Accordingly, the revision petition has no merit, hence dismissed.