M. SRINIVAS vs RAMA THULASI

THIS appeal arises out of the order dated 11th October, 2002 of the Andhra Pradesh State Commission dismissing the Complaint No. 125/96 of the petitioner-appellant wherein Mr. M. Srinivas alleged medical negligence against the opposite party-respondent No. 1, Dr. Rama Thulasi.

BRIEF facts of the case are as follows: The wife of the complainant was consulting Dr. Rama Thulasi, a Gynaecologist and a family doctor during her second pregnancy. She started going to the doctor from 10.12.1995 onwards when she was in the second month of pregnancy. The treatment was uneventful till 5.6.1996. The last consultation she had prior to 5.6.1996 was on 20.5.1996. It is the allegation of the complainant that his wife approached the doctor on 5.6.1996 with the complaint of vomiting, low appetite and uneasiness and that she was unable to pass urine. It is alleged that without properly paying any attention to the complaint of the patient, the doctor in a casual manner advised her to continue the medicines prescribed earlier. It is further alleged that the patient saw the doctor on 10.6.196 when she again complained of vomiting tendency, low appetite and urine problem. It is argued by the appellant that these symptoms are basic symptoms of jaundice. The doctor, however, without conducting any urine test, prescribed some antibiotics. The patient was admitted in a Nursing Home of O.P. No. 1 on 15th night at 10.30 p.m. and the caesarian operation was performed at 1.00 p.m. on 16.6.1996. A baby girl was delivered. As a prior procedure for the caesarian operation, urine was required to be removed from the bladder and it is only at that time that the doctor noticed that urine was yellow and suggestive of jaundice. But by the time it was too late and the patient had to be shifted to a better equipped hospital in the nearby city of Vijayawada on 18.6.1996 at 4.00 p.m. In spite of attempts made by the doctor at Vijayawada, the patient expired in the early hours of the next day i.e., at 2.00 a.m. on 19.6.1996. With these complaints, the petitioner approached the Andhra Pradesh State Commission alleging negligence on the part of the doctor and claiming compensation of Rs. 20 lakhs. The main arguments were that doctor failed to diagnose jaundice and that she performed an unnecessary caesarian operation.

The Andhra Pradesh State Commission which heard the matter observed that the patient did not disclose to the doctor any symptoms suggestive of jaundice and there was no clinical manifestation of jaundice till the caesarian operation was done and that the symptoms narrated and the clinical examination rightly identified by the doctor as due to lower urinary tract infection for which doctor gave appropriate medicine and that no negligence has been established against the doctor. Similarly, it came to the conclusion that the doctor had to perform an emergency caesarian operation because of foetal distress and due to non-progress in labour and that the action taken by the doctor was justified under the circumstances. It held that the complainant failed to prove negligence and accordingly dismissed the petition. The petitioner has come in appeal to us.

IT is admitted that the relevant period during which the alleged negligence has taken place is from 5.6.1996 to 18.6.1996. IT is admitted that during this period the patient was seen by the doctor on three occasions namely 5.6.1996, 10.6.1996 and 14.6.1996 as an out-patient. She was admitted in the Nursing Home on the night of 15.6.1996 and the caesarian operation was carried out at 1.00 p.m. on 16.6.1996. There is obviously a dispute about the events which took place on the first three days, i.e., 5.6.1996, 10.6.1996 and 14.6.1996 when the patient visited the doctor as an out-patient, the patient and the doctor giving different versions of the event. The State Commission in a very cogent and well reasoned order examined the events of these three days and rejected the version of the complainant and relied on the version of the doctor. We have carefully gone through the record, perused the written arguments and heard the parties. We are in agreement with the findings of the State Commission. In brief, the State Commission held that the patient visited the doctor on 20.5.1996 and was required to visit the doctor after a fortnight. It, therefore, relied on the version of the doctor that the visit of the patient on 5.6.1996 which was after a fortnight was a routine fortnightly visit and that the patient did not complain about low appetite or nausea. The complainant alleges that on 10.6.1996, the patient approached the doctor again with the same complaints. The doctor, however, contends that on that day the patient came with a complaint of painful urination and with no other complaint. On examination of the B.P. of the patient, it was found to be 140/100. It is argued before us on behalf of respondent No. 1 the doctor that there are about seven possible causes for painful urination in a woman, the most common cause being lower urinary tract infection. Based on clinical examination and history of the patient, respondent No. 1 excluded all other causes and found that painful urination due to lower unwary tract infection (UTI). Evidence has been brought on record to show that UTI is very common during pregnancy. After having reached a conclusion that if in a case of UTI, respondent No. 1 prescribed a safe antibiotic medicines for reducing acidity in urine and a medicine for reducing the blood pressure. The medicines prescribed were for 5 days and hence the patient came again on 14.6.1996. On examination the B.P. was found to be normal and the patient also reported relief from painful urination. However, she complained of heart burn and respondent No. 1 prescribed medicine for relief of heart burn. As held by the State Commission, the medicines prescribed on 14.6.1996 do not support the version of the complainant that on 14.6.1996 also the patient complained of loss of appetite, etc. An Ultrasonography of Gravid uterus done on 14.6.1996 revealed single live foetus with vertex presentation. It is also admitted that the patient started experiencing heavy pain on 15.6.1996 from 7.30 p.m. or so. She was taken to the Nursing Home of respondent No. 1 at 10.30 p.m. for admission and was put under observation for progress of labour. Case records show that the condition of the patient was recorded every two hours. At 10.45 a.m. next day i.e., 16.6.1996, respondent No. 1 noticed that there was no progress in labour and that the foetus developed stress. The foetal heart sounds were below normal and irregular. In such circumstances, respondent No. 1 based on clinical evidence, decided that an urgent caesarian operation is called for and accordingly performed by 1.00 p.m. We, therefore, do not see any deficiency in service or lack of proper appreciation of the medical condition.

THERE is also no substance in the allegation that the doctor failed to recognize jaundice well in time. We find from the extracts of numerous medical treatises brought on record that there is no support for the complainant''s contention that jaundice is a common occurrence amongst pregnant women, and that painful urination is a symptom of jaundice. On the contrary these authorities show that jaundice is a rare phenomenon in pregnant women, its incidence is being from 0.12% to 0.40%. It is clear that the patient never complained of any symptoms of jaundice and in fact there were no symptom of jaundice till 16.6.1996. On the other hand, the symptoms narrated by the patient and the clinical evaluation of the patient suggest a lower UTI which was promptly treated by respondent No. 1. Only when 300 mg. of urine was drained out of the bladder of the patient on 16.6.1996 it was noticed that urine was yellow in colour and as such jaundice was suspected. Even on that day, the eyes of the patient were not yellow. The eyes turned yellow on 17.6.1996. Extracts from "Obstetrics and Gynaecology for Post Graduates" by S.S. Ratnam page-5, Vol. 2 and from "Harrison''s Principles of Internal Medicines. p. 1730, 15th Edition'' were brought on record to show that in case of jaundice in clinical phase urine turns yellow, 1 to 5 days prior to eyes turning yellow. In the case before us the patient did not exhibit any symptoms of jaundice prior to 17th June, 1996. On 16.6.1996 the operating doctor found urine to be yellow only while extracting it from the bladder on the eve of the operation. It has also come in evidence that while incidence of jaundice in pregnant woman is rare even for a developing country like India, once jaundice develops in pregnant women, the chances of mortality are quite high. The case before us is one such unfortunate case where no symptoms of jaundice were exhibited or reported by the patient and there was no reason for the doctor to suspect the same. In the light of the given clinical history, respondent No. 1 did what can be reasonably expected from a Gynaecologist and the appellant has not been able to prove any incident of lapse on her part. As such the appeal fails and is dismissed. Appeal dismissed.