DR. R.P. GUPTA vs ANURAG & ORS.

"A twin pregnancy can mean twice the excitement and twice the fun for a mum-to-be. After all, what can be better than welcoming two bundles of joy? The Mo Mo twins are quite rare, but require special care and monitoring"

The brief facts of this case are - The complainant- Smt. Preeti Anand, underwent ultrasound (U.S.G.) at Dr. R. P. Gupta - the O.P., it was advised by Dr. Chaurasiya. It was reported as a single live fetus of 7 weeks. Again, 2 nd U.S.G. was performed by OP at 18 th week of pregnancy, which also revealed single fetus. Thereafter, patient''s health continued to deteriorate, hence 3 rd U.S.G. was performed at Sono Ultrasound Centre, which reported that she was carrying twin pregnancy and the babies'' weight was 14.63 gm and 14.42 gm. Thereafter, she gave birth to twin daughters, but only one could be saved due to best efforts of the doctors.Thus, the complainant alleging medical negligence during U.S.G., the O.P.failed to diagnose twin pregnancy, which caused death of one child, she and her husband Mr. Anurag filed a complaint before the District Forum seeking compensation of Rs.15,90,000/-.

The District Forum held that the O.P. has failed to detect twins at 18 weeks of pregnancy and allowed the complaint by an award of Rs.60,000/- as compensation with costs of Rs.1,500/-. Subsequently, the O.P. doctor filed first appeal before the State Commission, which was dismissed. Hence, the O.P./petitioner approached this Commission by this Revision Petition.

We have heard learned counsel for both the parties. Counsel for the petitioner submitted that it was a rare pregnancy of monchorionic, monoamniotic pregnancy, hence, difficult to diagnose by U.S.G. He relied upon different literature also. The O.P. performed U.S.G. study with due care and caution, hence there was no negligence. The learned counsel for the OP has drawn our attention to the medical report issued by the G R Medical College, Gwalior, A panel of doctors have opined that, "there are chances of error in diagnosing twin pregnancy, in cases of monochrionic monoamniotic pregnancy, which cannot be said to be negligence."

The Counsel for the complainant submitted the website references which show that detection of twin pregnancy is very possible in the 1 st Trimester (within 12 weeks). ( www.womensimagingservices.com.au ) "The chorionicity of a twin or higher order multiple pregnancy can be accurately determined at the time of First Trimester Screening or earlier if an ultrasound has been performed in the early first trimester. ( www.patient.co.uk/doctor/multiple-pregnancy )

Nearly all multiple pregnancies are diagnosed in the first trimester screening ( www.meetinpro.inf/plaza/registrants) Errors it any occur due to the carelessness of the radiologist or outdated equipment.

Errors can occur due to Inexperience (counting sacs'' instead of embryos) Inadequate vigilance/inadequate time Outdated/inadequate equipment

A perusal of USG reports and relevant literature, reveal the true fact that, monochrionic monoamniotic twins, share one inner membrane (amnion); but, the OP failed to diagnose a twin pregnancy during 1 st trimester, which could have been possible. OP had not adopted reasonable skill and care. It should be borne in mind that, the monochrionic pregnancies are classified as high risk, because such twinning is associated with fetal growth restriction due to Cord entanglement, malformations, twin-to-twin transfusion syndrome (TTS) and prematurity. Monochorionic Monoamniotic twins (MoMo) occur in one of 10,000 pregnancies. Monoamniotic twins are quite rare, but require special care, follow up and monitoring. Some mothers may need hospitalization for constant monitoring Therefore, wrong diagnosis or wrong USG report leads the doctor in mismanagement of patient. The panel of doctors opined that, it was error of judgment, and not a negligence. But, we are hesitant to accept the opinion of panel, because that error was as a result of negligence and due to lack of care.

The Hon''ble Supreme Court in Indian Medical Association Vs. V. P. Shantha [(1995) 6SSC 651], and Jacob Mathew V State of Punjab & Anr, (2005) 6 SSC 1= III (2005) CPJ 9 (SC) had concluded that, "a professional may be held liable on one of two findings : either he was not possessed of requisite skill which he professed to have possessed, or, he did not exercise reasonable competence in given case, the skill which he did possess." Hon''ble Supreme Court in Post Graduate Institute of Medical Education and Research, Chandigarh, Vs. Jaspal Singh & Ors ., II (2009) 7 SCC 330, it was laid down that, " the failure to perform the duties with reasonable competence amounts to negligence."

In the Consumer Complaint No. 170/1999 Prem Prakash Rajagaria Vs Nagarmal Modi Seva Sadan & Ors ; I (2013) CPJ 672 (NC) decided by this commission, Hon''ble Mr. Justice J. M. Malik held " the Opposite parties jointly and severally liable for medical negligence due to dereliction of duty by OPs."

Also the Bolam''s Test explains about the standard of care and reasonable practice of the doctor. Therefore, the sole reason that, usual terms like "error" and "mistake," create lot of confusion, therefore we stick on with the standard of care , i.e., that was expected from the OP. The OP failed on those counts.

Therefore, we do not find any fault with the order of State Commission, and there is no merit in this revision, thus dismissed. There shall be no order to costs.