HARJEET KAUR vs SANTOKBA DURLABHJI MEMORIAL TRUST

THIS complaint has been filed under Section 12 of C.P. Act, 1986 to claim a total compensation of Rs. 15,28,858/- under different counts as narrated in the complaint against the O.Ps.-SDM Trust and SDM Hospital, Jaipur.

FACTS relevant for disposal of this complaint in brief are that Smt. Harjeet Kaur was having a pregnancy in the year 1993 and had got her check-up from one Dr. Sharda Rao working in the hospital of O.P. No. 1. It is the case of the complainants that Smt. Kaur got herself medically checked on 11 occasions by Dr. Sharda Rao between the period from 21.12.1993 to 5.8.1994. After her medical check-up, Dr. Rao advised to get a Sonography done as Smt. Kaur had some inconvenience. That after receipt of the Sonography Report, the complainant alleges, Dr. Rao told her that there is no head in the child who is progressing birth in the womb and that there are feeble heart-throbs of the child; hence either a dead child would be given birth or that the child would die immediately after the birth. On coming to know about this, complainant Smt. Kaur was stunned but as she has no option, she had to rely upon the version given by Dr. Rao. According to the complainant, on suggestion that Sonography be got done at some other place, she was rebuked and was told that no better facility is available at any other place than at their own. The complainant Smt. Kaur, therefore, was got admitted in the Hospital (O.P. No. 2) on 5.8.1994 after payment of requisite charges. The complainant''s grievance further is that after admission, she was not attended for almost 12-16 hours despite repeated requests made by her and her husband nor she was got medically examined by any expert medical person. The complainant further narrates that she was medically examined on 6.8.1994 by one Dr. Preeti Sharma of Hospital (O.P. No. 2) which advised that an immediate operation is needed for safe delivery of the child. However, before the operation, one more Sonography was got done and thereafter the complainant Smt. Kaur gave birth to a female child (complainant No. 2) which not only possessed the head but that her heart-throbs were also normal. It is the grievance of the complainant that it is because of the negligence and unskillfulness of the doctors of the O.Ps. that during operation, the child got a number of cuts in her mouth and hence when her condition became serious, the child was kept in ICU and 16-18 stitches were administered in the mouth of the child.

The complainant, therefore, asserted that because of a false report conveyed by Dr. Rao that the child in the womb did not possess a head or that her heart-throbs were very weak; not only the complainant but all her family members went through acute mental agony and physical discomfort. That it was only because of the negligence and unskillfulness of the doctors of the O.Ps. that the complainant Smt. Kaur could not deliver a normal child but the child could be delivered through a caesarean operation which further enhanced their mental agony and physical discomfort. The complainant, therefore, claimed a total amount of Rs. 15,28,858/- from the O.Ps.

THE complaint has been resisted by the O.Ps. by presenting a written version. It is the stand of the O.Ps. that Smt. Kaur is not a consumer since all the payments and expenses have been made by her husband Shri Jitendra Pal Singh and secondly that there has been no negligence or unskillfulness on the part of the doctors of the O.Ps. who attended upon Smt. Kaur althrough and after the delivery of the child. It has also been stated that when Smt. Kaur was medically examined by Dr. Rao on 5.8.1994, she was already overdue for delivery by two days who complained of decreased foetal movements and hence she was advised to undergo Sonography. On Sonography according to the O.Ps. the position of the foetus in the womb was found to be transverse and hence the Sonographist was unable to visualise the head at the end of the vertebral column. According to the O.Ps., the said transverse situation of the foetus in the womb is technically called anencephaly and that it is settled in medical jurisprudence that a child with anencephaly is either born still or if born alive does not survive long and hence the implications of this non-visualisation of the head of the child on sonographic examination were duly explained to the complainant. It has further been averred by the O.Ps. that there has been no negligence on their part in attending to the complainant and that there was constant monitoring by the staff and doctors on duty of the complainant not only in the Labour Room but also otherwise. According to the O.Ps., when the complainant was examined by her attending Obstetrician, "after her admission at 2.00 p.m. the patient was having labour pain with mild uterine contractions and that cervix had been taken up reflecting the earlier stage of labour. Since the foetal heart sounds were normal, there was no manifest foetal distress and the patient''s general condition was good. When the Obstetrician examined her again at 6.00 p.m., the labour was progressing satisfactorily and was uneventful and the patient was advised routine medicines for the night and monitoring continued. According to the O.Ps. at 3.00 p.m. on 6.8.1994 the patient''s labour pains and uterine contractions became of moderate intensity and on the advice of the Obstetrician three injections were given at 3.30, 4.00 and 4.30 a.m. to facilitate the dilation of cervix, the mouth of womb. At 6.00 a.m. a plain glucose drip was started as advised in anticipation of management of the case. Thereafter, the patient was re-examined at 8.30 a.m. and by that time the labour had progressed sufficiently and cervix too was fully taken up and fully dilated and the membranes were bulging. The Obstetrician thereupon artificially ruptured the membranes to accelerate the labour but as the liquor (the water surrounding the child in the womb) drained and the presenting part could be discerned; it was found to be the ''elbow'' of the child. Since a child cannot be delivered with the elbow presentation, it was pushed back in the womb although the foetal monitored showed normal foetal heart sounds with evidence of foetal distress, but the lie of the child was transverse. According to the O.Ps. to correct the position of the child in order to enable vaginal delivery, the Obstetrician had to put her hand inside the womb and feel the foetal parts. Technically this procedure is called intrauterine examination and internal version. It has further been stated by the O.Ps. that after pushing the elbow of the child inside the womb and correcting partially the position of the child, the Obstetrician felt the head of the child and to attempt to deliver a child with formed head vaginally after internal version involves risk to the foetus and the mother hence finding that the condition of both the complainants was good, the attempt was abandoned in favour of a safer alternative available. It is further stated by the O.Ps. that as the Obstetrician felt the head of the child during intrauterine examination and manoeuvre; a fresh ultrasound examination was suggested and the patient was taken to the ultrasound room for examination where she was examined by the same Sonologist who performed the sonography earlier. The ultrasound probe this time readily picked up the image of the foetal head and after completion of the ultrasound examination of the foetus parts and its condition which was decided by Dr. Preeti Sharma, the Obstetrician had to go for immediate caesarean section and thereupon after obtaining the consent for operation, the Anaesthetist was summoned and a Paediatrician was also made available as per routine in caesarean delivery to manage the child as is done in the caesarean operation.

IT has, therefore, been vehemently denied by the O.P. that the doctors who attended upon the complainant Smt. Kaur were negligent in any way or they were unskilled or that they caused any mental agony and discomfort to the complainant and her family members. IT has further been stated by the O.Ps. that since the child was delivered by caesarean section and when handed over to the Paediatrician for management; the Paediatrician found bleeding from the mouth of the child. Accordingly the blood was sucked from the mouth and the respiratory passage was cleared of the secretions and the blood, that the child had aspirated in the attempt to breathe. Once cleared, the bleeding was found to be from underneath the child''s tongue and on close examination, it was found to arise from a small tear of the delicate membranous fold that attaches the tongue to the floor of the mouth. According to the O.Ps., this obviously was a "birth injury" probably sustained while Obstetrician was conducting the intrauterine examination of the foetus parts and attempting to correct the abnormal position of the foetus (child) by internal version. Further the Paediatrician attempted to stop the bleeding with local pressure and application of ''Durgicel'' (a type of material) but the bleeding continued as a tiny blood vessel in the mocous fold was bleeding; and required to be ligated and this was achieved by the application of a few very fine stitches. IT has, therefore, been asserted by the O.Ps. that the allegations made by the complainants that the injury to the child was caused intentionally and negligently and inflicted by the attending Paediatrician and the nursing staff and that 16-18 stitches were placed in the tiny mouth and that too to harm the child; is preposterous and wild. IT has, therefore, been vehemently asserted that the O.Ps. or their doctors have in any way been negligent or careless in attending upon the complainant in the delivery of the child. The O.Ps., therefore, have asserted that the complaint being without any substance be dismissed with cost. We heard the learned Counsel for the complainant and the O.Ps. at great length and have carefully gone through the material and evidence made available by the parties. It may be stated at the outset that the whole basis of the claim advanced by the complainant is the allegation of some injury in the mouth of the child at the time of delivery of Smt. Kaur and non-visibility of the ''head'' of the child in womb in the sonography done on 5.8.1994. Except these grievances, there is no complaint by the complainants that the newly born child suffered from any disability or physical deformity. No evidence has been adduced on behalf of the complainants to exhibit that despite the alleged injury to the child in her mouth, the medical team/doctors attending upon Smt. Kaur failed to manage it efficiently. On the other hand, the O.Ps. have given a detailed account as to the steps which were undertaken by the O.Ps. to see that not only a safe delivery is done but also that no danger to the lives of the mother and the child is caused. The care and caution exhibited by the doctors of the O.Ps. have been given in detail in their version. The O.Ps. have also given a correct account as to why the head of the inborne child (in the foetus) was not visible when the sonography of Smt. Kaur was performed on 5.8.1994. According to the O.Ps. the head in the first sonography done was not discernable because of the lie of the child in the womb and accordingly in Annexure 14 which gives another sectional image of the child''s vertebral column which does not show the head at its one end. In other words according to the O.Ps., since the position of the child in the womb was abnormal, the ultrasound probe did not pick up the deeply and distantly located foetal structure in such an abnormally positioned child can be best explained by the experts on the subject. According to the O.Ps., the possibility and probability of false positive and false negative images, the limitation of specificity and sensitivity inherent in the test is a matter of expert understanding. It is asserted that in view of this abnormal situation, the correct position was explained to Smt. Kaur at the time of and after the first sonography was done. However, at the time, when it was found that the presentation of the child before the delivery appeared to be through elbow, the Obstetrician had to conduct intrauterine examination of the foetus parts and also attempt to correct the abnormal position of the child by internal version and in that attempt; which was essential to be performed to save the life of the child and the mother, a slight injury in the mouth of the child could have been caused that too was immediately attended upon and all possible medical steps were taken to see that the child does not breathe her last and for that purpose the child had to be kept in ICU for some time. This whole version of the O.Ps. has been narrated by the Medical Superintendent of the O.P.-Hospital in the report furnished to Smt. Kaur through his communication dated 22.11.1994. The report of the Medical Superintendent (Annexure 26) is reproduced here : "Harjeet Kaur, aged 25 years, OPD No. 93/36879, IPD No. 155060, was under the ante-natal care of Dr. Sharada Rao, Consultant Obstetrician and Gynaecologist, SDM Hospital, Jaipur. On 5.8.1994, she consulted Dr. Rao with complaints of diminished foetal movements. Dr. Rao felt the foetal heart sounds to be regular but thought the lie might be transverse and sought an ultrasound scan. The radiologist reported the scan as showing an anencephaly and on repeated attempts could not visualise the head. Dr. Rao advised Mrs. Kaur admission and, since she was already overdue, to undergo induction of labour. The lady was admitted into the ward on 5.8.1994 at about 12 noon and labour was induced. Dr. Preeti Sharma, Consultant Obstetrician and Gynaecologist, examined Mrs. Kaur at 2 and 6 p.m. that day and advised routine medication. During the night, labour progressed normally and the next morning (6.8.1994), at about 8.30 a.m., Dr. Preeti Sharma found the cervix to be fully dilated. An artificial rapture of the membranes was done and vaginal examination followed. Dr. Preeti Sharma attempted an internal version and delivery per vaginum but thought she could feel the head during examination and the manoeuvre, which prompted her to immediately question the diagnosis of anencephaly and order a fresh ultrasound examination. This showed the head of the baby to be present. Dr. Preeti Sharma then performed a caesarean section on the mother and delivered a normal, healthy female child. The baby was handed over to the Paediatrician on duty who noticed fresh bleeding from the mouth. This was found to be due to a frenular tear of the tongue. The wound was probably sustained during the internal version. The wound was sutured and bleeding ceased. The baby received a blood-transfusion and the post-transfusion haemoglobin was 16.4 G/d1. The baby was nursed in the Sick Baby Care Unit. The mother''s post-delivery course was uneventful.

The baby was initially managed with IV fluids and was shortly thereafter kept on nasogastric feeds because of the oral wound. Expressed breast milk was given via tube. Eventually the baby could be put to the breast. She developed a mild pneumonia from which she recovered fully with antibiotics. At the time of discharge she had oral thrush for which she was given nystatin. She was being followed up in the OPD and was in good health."

The aforesaid report of the Medical Superintendent and all steps taken by the medical personnel of the O.Ps. exhibit that neither the O.Ps. nor all of the doctors working with them and attending upon Smt. Kaur had at any point of time were careless, negligent or unattentive or could be termed as unskilled medical professionals.

IT may also be stated that the complainant Smt. Kaur was admitted in the Hospital on 5.8.1994. Not only she was duly attended upon but during the delivery as also after the delivery of the child all care, caution and skill was employed by the O.Ps. till the complainant Smt. Kaur and the child were discharged from the ICU/Hospital on 25.8.1994. The complainant has not produced any evidence of any expert in Medical Sciences to establish that the O.Ps. or their doctors have been in any way negligent in attending upon the mother and the child or were unskillful which could support the allegations made by the complainant against the O.Ps.

CONSEQUENTLY, in our view, the complaint filed by the complainants is without any substance and merits is hereby rejected. In the facts and circumstances of the case both the parties shall bear their own cost. Order accordingly. Complaint dismissed.