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2008 DIGILAW 764 (MP)

Kishore Singh Bhadoria v. Reeta Y. Shinde

2008-06-25

N.K.JAIN, PRAMILA S.KUMAR

body2008
JUDGMENT : N.K.Jain, J.: - Thisappeal is by complainants whose complaint against respondents has beendismissed by District Consumer Disputes Redressal Forum, Ujjain vide its order dated 23-8-2005 passed in C.C. No. 190/04. 2.Respondent No. 1-Dr. Smt . Reeta Shinde is a private medical practitioner gynecologist.She along with her husband Dr. Yashwant Shinde -respondent No. 2 who is a Surgeon (MBBS, MS) inGeneral Surgery run a private nursing home namely Shinde Nursing & Maternity Home at Ujjain . They areinsured with respondent No. 3-the New India Assurance Company Ltd., underProfessional Indemnity Dr. Insurance Policy for a sum of Rs .5 lacs each. Late Smt . Savita Bhadoria aged 28 years,wife of appellant No. 1 and mother of appellants Nos. 2 and 3 was admitted in Shinde Nursing Home on the morning of 1st July, 2004 . She was having eight monthspregnancy and had already undergone LSCS delivery less than two years back. Shecomplained of sudden on-set of Chakkar and Ghabrahat since a day before (i.e., 30-6-2004 ). On examination she was diagnosed tobe a case of severe pre- eclampsia having very highblood pressure 190/130. Emergency LSCS was done at the said Nursing Home underspinal an aesthesia the same morning at 9.05 a.m. She delivered a female baby carrying weight 1.5 kg. The child was seen by Dr. Santosh Chandwani . It appearsthat first post operative day was uneventful. However, on the next morning thepatient complained of drowsiness and breathlessness. Her urine out-put was alsodecreased. She was seen by Dr. Sanjay Bhoraskar , aPhysician and was given medicines as per his advise .However, her BP continued to rise 130/110 to 160/110. In the evening she was'referred to T. Choithram Hospital, Indore for further management andtreatment. She expired on 14-7-2004 at 4:35 A.M. while under treatment atthe said hospital. The cause of death as per record of the hospital was cardio-respiratoryfailure resulting from post operative DIG c ARF c ARDS (HELLP syndrome). 3.The case of appellants before the Forum below was that caesarian operation oflate Smt . Savita was donein haste, without proper examination and notwithstanding the protest of herfamily members. It was further alleged that the operation was not performed byDr. Smt . Rita herself but by someone else (obviouslythe reference is to Dr. Yashwant Shinde-R.2). Therewas no proper post operative care either. Condition of the patient starteddeteriorating in the afternoon , but no doctor wasavailable in the hospital till late evening. It was further alleged that the operation was not performed byDr. Smt . Rita herself but by someone else (obviouslythe reference is to Dr. Yashwant Shinde-R.2). Therewas no proper post operative care either. Condition of the patient starteddeteriorating in the afternoon , but no doctor wasavailable in the hospital till late evening. In the night the patient developedurine problem. The patient was not allowed to be taken to some other hospitaland instead shown to another local doctor. It was only when her conditionbecame uncontrollable that she was allowed to be taken to T. Choithram Hospital, Indore . It was thus, contendedthat opposite party-doctors were negligent in treating the patient and whichultimately led to her death. Appellants claimed compensation Rs . 15 lacs . 4.Opposite party-respondents Nos. 1 and 2 by their joint reply and No. 3 by it's separate reply, denied all the allegations made by thecomplainants and it was submitted that it being a case of pre- eclampsia , emergency LSCS was done by Dr. Smt . Rita Shinde herself so as tosave the lives of mother and the child. All necessary examinations were donebefore and after the procedure and due post operative care was taken in thehospital which is fully equipped for such kind of procedures. The complicationssuffered by the patient were known ones and every effort was made to controland cure the same. Since the patient needed further management and treatment,she was referred to T. Choithram Hospital. 5.The Forum below on consideration of the evidentiary material on recorddismissed the complaint of appellant holding that there was no negligence onthe part of opposite party-doctors. 6.We have heard Shri K.S. Bhadoriya ,learned Counsel for appellant, Shri V.K. Ojha , learned Counsel for respondent Nos. 1 and 2 and Shri K.K. Khandelwal , learned Counsel for respondent No. 3. Respondent No. 2-Dr. Yeshwant Shinde also appeared inperson and addressed the Commission. We have also very carefully gone throughthe evidentiary material on record. 7.At the out-set it may be observed that there is no expert evidence adduced bycomplainants to substantiate their allegations against respondent-doctors. Onthe contrary the treatment papers of T. Choithram Hospital, Indore confirmed the initial diagnosis of pre- exlampsia madeby respondent-doctors. There is absolutely no reference not even whisper in thetreatment papers of T. Choithram Hospital, Indore about any lapse or negligence on the part ofrespondent-doctors while performing LSCS procedure on the deceased patient. Onthe contrary the treatment papers of T. Choithram Hospital, Indore confirmed the initial diagnosis of pre- exlampsia madeby respondent-doctors. There is absolutely no reference not even whisper in thetreatment papers of T. Choithram Hospital, Indore about any lapse or negligence on the part ofrespondent-doctors while performing LSCS procedure on the deceased patient. Itis further seen that the patient prior to her admission on 1-7-2004 , was being examined from time to time byDr. Smt . Rita Shinde andgiven necessary prenatal treatment. Her sonography was got done on 6-3-2004 andother necessary tests were also performed. Her expected date of delivery was August 1 ,2004 but she came to respondents' Hospital on 1-7-2004 with complaint of sudden on-set of Chakkar and Ghabrahat since a day before ( 30-6-2004 ). On examination it was found that she washaving pregnancy induced blood pressure 190/130. She already has had LSCSprocedure less than two years back and there was tenderness in the scar ofprevious operation. It was a clear case of pre- eclampsia which required emergency LSCS which was performed after obtaining due consentfrom patient's husband. Dr. Smt . Rita Shinde in her affidavit has testified that the entireprocedure was performed by her, not by respondent No. 2 who even otherwise is aqualified doctor having degree of MBBS and MS. Dr. Smt .Rita Shinde is a qualified and experienced gynecologist.Treatment papers filed on record further revealed that soon after the delivery,the child was got examined by Child Specialist and first operation day wasrather uneventful. Blood pressure of the patient was the well under control130/80. The patient was given all necessary treatment and monitoredcontinuously. It was only on the morning of 2-7-2004 that she developed urine problem and her BP againstarted rising. She was promptly shown to Dr. Bhoraskar ,a qualified physician and necessary treatment as per his advise was started. Since her condition showed no much improvement, she was referredto a higher specialty centre T. Choithram Hospital, Indore . As already pointed out,there is nothing in the treatment papers of T. Choithram Hospital, Indore to show that the initial diagnosis and treatment given by respondent-doctor wasin any manner wrong or faulty. 8.As per Hirrison's Principles of Internal Medicine(Volume 1 Chapter 7 at page 25) "pre- eclampsia means : -- " Preeclampsia is disease of late pregnancy in whichhypertension is associated with hepatic, neurologic , hematologic , or renal involvement. 8.As per Hirrison's Principles of Internal Medicine(Volume 1 Chapter 7 at page 25) "pre- eclampsia means : -- " Preeclampsia is disease of late pregnancy in whichhypertension is associated with hepatic, neurologic , hematologic , or renal involvement. Rapid development ofedema, particularly of the face and hands, along with a rise in blood pressure,often signals the onset of this condition. Jaundice and abnormal liver functionmay be present. Hyperreflexia , visual disturbances,and headache indicate neurologic involvement andraise concern for the development of convulsions, termed ' eclampsia '. Hematologic manifestations of preeclampsia include thrombocytopenia with elevated levels of lactate dehydrogenase (LDH), microangiopathic hemolytic anemia, andthrombocytopenia. This condition is termed HELLP ( hemolysis ,elevated liver function tests, low platelets). In fulminant preeclampsia , dissenminated intravascular coagulation may cause areduction in plasma fibrinogen and elevated circulating fibrin degration produces (Chap. 119)." While dealing withthe treatment learned author states : - "Once preeclampsia is diagnosed, hospitalization is indicated,since the disease can progress rapidly to multisystem involvement, including eclampsia , characterized byconvulsions. The definitive treatment of preeclampsia and eclampsia is delivery of the concept us, whichshould be carried out promptly if fetal size and maturity are adequate." Inthe instant case also the pregnancy of the patient was adequate (eight months)to carry out the procedure. 9.In Mosby's Medical Dictionary ' eclampsia 'is termed as :- "the gravest form ofpregnancy-induced hypertension." Itfurther says : - "Thematernal mortality rate in eclampsia is 10%; the fetel mortality rate is 25%. Eclampsia occurs in 0.2% of pregnancies. The cause is not known." 10.It will be thus, seen that LSCS was the first thing required for the treatmentof the patient and that what exactly the opposite party-doctors did. Theprocedure undertaken was as per standard laid down by the medical science.Follow-up treatment was also given and condition of both the mother and childwas monitored continuously. There was absolutely no negligence on the part ofrespondent-doctors. 11.The Hon'ble Supreme Court in Jacob Mathew, 2005 (5)M.P.H.T. 462 (SC) = (2005) 6 SCC 1 has held : - "Fora medical accident or failure, the responsibility may lie with the medicalpractitioner, and equally it may not. The inadequacies of the system, thespecific circumstances of the case, the nature of human psychology itself andsheer chance may have combined to produce a result in which the doctor'scontribution is either relatively or completely blameless. The human body andits working is nothing less than a highly complex machine. The inadequacies of the system, thespecific circumstances of the case, the nature of human psychology itself andsheer chance may have combined to produce a result in which the doctor'scontribution is either relatively or completely blameless. The human body andits working is nothing less than a highly complex machine. Coupled with thecomplexities of medical science, the scope for misimpressions, misgivings andmisplaced allegations against the operator i.e., the doctor, cannot be ruledout." 12.In the instant case also, the complications suffered by the patient were knowncomplications and every effort was made by respondent-doctors as also at T. Choithram Hospital to control and cure the same. Theunfortunate death of the patient could not be attributed to any negligence onthe part of treating doctors. The complaint of appellants, in our opinion, hasbeen rightly dismissed by the District Forum and so should be the fate of thisappeal. Dismissed. No order as to costs.