Mohammed Imran v. State Of Telangana, Rep. By Its Principal Secretary, Health, Medical And Family Welfare
2025-12-30
NAGESH BHEEMAPAKA
body2025
DigiLaw.ai
ORDER : NAGESH BHEEMAPAKA, J. Petitioners state that Petitioner No.2, Dr. Tooba Mariyam, conceived on 15.03.2024, with her last menstrual period being on the said date, and the expected date of delivery being 19.12.2024. From the third month of pregnancy onwards, Petitioner No.2 was under regular antenatal supervision and follow-up at Respondent No.7 - Fernandez Stork Home. Regular consultation fees and charges for diagnostic investigations were paid to the said hospital throughout the antenatal period. It is contended that the first ultrasound scan was conducted on 22.06.2024 at Respondent No.7 hospital by Respondent No.10 - Dr. Suseela, which revealed no abnormalities and was reported to be normal. Thereafter, Petitioner No.2 attended outpatient consultation with Respondent No.10 on 25.06.2024. Subsequently, a TIFFA scan was conducted on 03.08.2024 at the same hospital by Respondent No.10, which revealed increased resistance of blood flow in both uterine arteries. According to Petitioners, such a finding is a significant clinical indicator pointing towards potential life-threatening complications to both the mother and the fetus, including fetal growth restriction and preeclampsia. 1.1. Petitioners state that despite being a senior obstetrician and fetal medicine specialist, Respondent No.10 failed to appreciate the seriousness of the said finding and did not prescribe preventive medication such as Tab. Aspirin or Inj. Heparin, which could have mitigated the risk. Respondent No.10 neither advised frequent Doppler surveillance nor reviewed the uterine artery Doppler findings thereafter, though two additional scans were conducted for assessing cervical length. Repeated requests and suggestions made by them, being doctors themselves, to take preventive measures and prolong the pregnancy to near-term were ignored. 1.2. It is further contended, during a routine outpatient consultation on 17.09.2024, Respondent No.10 observed that size of the uterus was not corresponding to the gestational age, which was indicative of fetal growth restriction. Despite such observation, Respondent No. 10 allegedly advised only a routine scan to be conducted on 28.09.2024, instead of ordering an immediate emergency scan or initiating urgent corrective measures. This delay aggravated the fetal condition and resulted in avoidable deterioration. 1.3. Petitioners state that ultrasound scan conducted on 28.09.2024 revealed severe restriction of blood flow to the fetus, clearly establishing fetal growth restriction. Only thereafter did Respondent No.10 advise immediate admission. Accordingly, Petitioner No.2 was admitted at Respondent No.7 hospital on 29.09.2024.
This delay aggravated the fetal condition and resulted in avoidable deterioration. 1.3. Petitioners state that ultrasound scan conducted on 28.09.2024 revealed severe restriction of blood flow to the fetus, clearly establishing fetal growth restriction. Only thereafter did Respondent No.10 advise immediate admission. Accordingly, Petitioner No.2 was admitted at Respondent No.7 hospital on 29.09.2024. On 30.09.2024, at about 11.03 a.m., an emergency caesarean section was performed by Respondent No. 10, resulting in premature birth of a male infant at 28 weeks and 4 days gestation, with a birth weight of approximately 800 grams. Following the delivery, Petitioner No.2 developed high blood pressure, which was a known complication of increased uterine artery resistance detected earlier and could have been prevented with timely medical intervention. The premature baby was immediately admitted to Neonatal Intensive Care Unit (NICU) and was placed on non-invasive ventilation (CPAP) from 30.09.2024 onwards. 1.4. Petitioners state that the baby showed gradual and consistent improvement over the subsequent weeks. The baby was taken off CPAP on 17.10.2024 and was maintained on high- flow nasal oxygen from 17.10.2024 to 27.10.2024. The baby was also tolerating progressively increasing external feeds, up to 16 ml every two hours through a feeding tube by the evening of 27.10.2024. It is asserted that the NICU team had planned to discharge the baby within a week, considering the stable clinical improvement. However, on 27.10.2024 at around 8.00 p.m., the NICU team noticed progressive abdominal distension, increased gastric aspirates through the feeding tube, hypotension, and increased work of breathing. In such circumstances feeding ought to have been stopped immediately; however, feeding was continued despite worsening abdominal signs. The baby was started on medications for low blood pressure and was again placed on non-invasive ventilation, indicating the development of a serious and acute medical condition. 1.5. Petitioners state that baby's condition continued to deteriorate. A 2D echocardiogram conducted on 28.10.2024 at around 5.00 a.m. showed a collapsed inferior vena cava, confirming hypotension. At about 9.30 a.m. an ultrasound of the abdomen revealed free fluid in the abdomen, bowel wall edema and intraluminal gas. By 10.00 a.m., baby was suspected to be suffering from necrotizing enterocolitis (NEC), malrotation, or cow milk protein allergy. Suspicion of NEC was further corroborated by X-ray and ultrasound findings. 1.6.
At about 9.30 a.m. an ultrasound of the abdomen revealed free fluid in the abdomen, bowel wall edema and intraluminal gas. By 10.00 a.m., baby was suspected to be suffering from necrotizing enterocolitis (NEC), malrotation, or cow milk protein allergy. Suspicion of NEC was further corroborated by X-ray and ultrasound findings. 1.6. It is the specific case of Petitioners that despite clear indicators of NEC, a pediatric surgeon was not immediately called; consultation with a pediatric surgeon is mandatory once NEC is suspected, particularly in a premature infant. Though several surgical indications were present, including persistent abdominal distension, free fluid in the abdomen, persistent hypotension despite conservative management, and a palpable abdominal mass noted on 29.10.2024 at about 8.00 a.m., the surgical intervention was unjustifiably delayed. Surgery should have been performed on an emergency basis on 28.10.2024 itself, which could have prevented extensive damage to the intestines. Instead, the surgery for NEC commenced only on 29.10.2024 at 9.11 a.m. and was completed at 10.23 a.m. It is alleged that due to the delay, significant and irreversible damage occurred to the baby's intestines. 1.7. The core grievance of Petitioners is that during the said surgery, Respondents 7 to 9 informed that the right kidney of the baby had been removed, allegedly because it had "popped out", was "avulsed", or was "devascularised". Petitioners categorically dispute these explanations and contend that they are mutually inconsistent, medically untenable, and unsupported by anatomical principles. Kidney is a retroperitoneal organ, firmly held in place by surrounding structures, and could not have been incidentally removed during intestinal surgery. They rely upon multiple inconsistencies and discrepancies in the operative notes, postoperative counselling notes, anaesthesia records and case sheets. These include contradictions regarding the amount of blood loss, discrepancies in timing of documentation, absence of detailed step-by-step surgical notes explaining how the kidney was removed, and the absence of perinephric fat in the specimen sent for histopathological examination. Petitioners assert that the histopathology report showed the kidney to be structurally normal, thereby disproving the theory that it was inflamed or involved in an inflammatory mass. 1.8. It is further contended that expert opinion submitted by Niloufer Hospital dated 29.09.2025 is incomplete, evasive and biased, as Respondent No.8, Dr. Nadipally Bhuvaneshwar Rao, is the Head of the Department of Pediatric Surgery at Niloufer Hospital.
1.8. It is further contended that expert opinion submitted by Niloufer Hospital dated 29.09.2025 is incomplete, evasive and biased, as Respondent No.8, Dr. Nadipally Bhuvaneshwar Rao, is the Head of the Department of Pediatric Surgery at Niloufer Hospital. According to Petitioners, the report fails to address the core issue of how and why the kidney was removed and suffers from a clear conflict of interest. Petitioners therefore seek rejection of the said opinion and constitution of an independent medical board at the All India Institute of Medical Sciences, New Delhi, comprising pediatric surgeons, pediatric nephrologists and neonatologists. According to petitioners, the cumulative acts and omissions of Respondents 7 to 10 constitute gross medical negligence, breach of duty of care, breach of informed consent, violation of medical ethics and professional standards prescribed by the State Medical Council and National Medical Commission, and infringement of fundamental right to life guaranteed under Article 21 of the Constitution, thereby warranting interference by this Court under Article 226. 2. Respondents 7 to 10 raised a preliminary objection as to the maintainability of the writ petition. It is contended that Respondent No.7 is a private hospital run by Fernandez Foundation, a not-for-profit charitable organization incorporated under Section 8 of the Companies Act, 2013, and Respondents 8 to 10 are private medical professionals employed therein. It is asserted that none of the said respondents are discharging any public, statutory or sovereign function so as to attract the writ jurisdiction of this Court under Article 226 of the Constitution. 2.1. It is stated, reliefs sought by Petitioners pertain to alleged medical negligence, reimbursement of medical expenses, initiation of criminal proceedings, and disciplinary action against doctors, all of which fall outside the scope of writ jurisdiction. It is contended that such disputes involve private law rights and obligations and require adjudication of disputed questions of fact, including assessment of medical evidence and expert testimony, which cannot be undertaken in proceedings under Article 226. Further, Petitioners have efficacious and alternate statutory remedies available under law. With regard to the grievance of non-registration of FIR, it is stated that Petitioners ought to have availed remedies under Sections 154(3), 156(3) or 200 of the Code of Criminal Procedure. For claims relating to medical negligence and reimbursement of medical expenses, appropriate remedy lies before the civil court or the consumer fora constituted under the Consumer Protection Act.
With regard to the grievance of non-registration of FIR, it is stated that Petitioners ought to have availed remedies under Sections 154(3), 156(3) or 200 of the Code of Criminal Procedure. For claims relating to medical negligence and reimbursement of medical expenses, appropriate remedy lies before the civil court or the consumer fora constituted under the Consumer Protection Act. For disciplinary action against doctors, the statutory remedy lies before the State Medical Council or the National Medical Commission. Bypassing all such remedies, directly invoking writ jurisdiction amounts to abuse of process and forum shopping. 2.2. Respondents further allege that Petitioners have not approached this Court with clean hands and have adopted coercive and vexatious methods to pressurize them. Petitioners first issued a legal notice making untenable monetary demands, thereafter lodged a police complaint which was not registered as an FIR, and upon failure therein, filed the present writ petition with false, exaggerated and scandalous allegations. This writ petition is motivated by an oblique intention and is liable to be dismissed. 2.3. On merits, it is stated, Respondent No.10, managed the antenatal care of Petitioner No.2 strictly in accordance with established medical protocols and evidence- based practice. The first trimester scan and anomaly scan were normal, and although increased uterine artery resistance was noted at around 20 weeks, medical literature, including ASPREE trial, clearly establishes that low-dose aspirin is beneficial only if initiated before 16 weeks of gestation. Therefore, according to Respondents, aspirin therapy was not indicated at the stage when the finding was detected. 2.4. It is further contended, at 26.5 weeks of gestation, the fetal height was appropriate and did not indicate fetal growth restriction. At 28 weeks, when abnormal Doppler flows and fetal growth restriction were detected, Petitioner No.2 was advised immediate admission for steroids and monitoring. It is asserted that Petitioner No.2 chose to get admitted only on the following day. Steroids were administered immediately upon admission on 29.09.2024, and on 30.09.2024, a non-stress test revealed fetal distress necessitating an emergency caesarean section. Baby was born at 28 weeks and 4 days gestation with an extremely low birth weight of approximately 800 grams, and that extreme prematurity and severe growth restriction are well- known to be associated with complications such as necrotizing enterocolitis, infections, respiratory distress and prolonged NICU stay, despite the best possible medical care.
Baby was born at 28 weeks and 4 days gestation with an extremely low birth weight of approximately 800 grams, and that extreme prematurity and severe growth restriction are well- known to be associated with complications such as necrotizing enterocolitis, infections, respiratory distress and prolonged NICU stay, despite the best possible medical care. It is asserted that such complications cannot, by themselves, be attributed to negligence. 2.5. It is contended that the baby was continuously monitored in the NICU and managed as per established neonatal protocols, including those followed at premier institutions such as AIIMS. Functional echocardiography, blood gas monitoring, serial imaging and clinical assessments were conducted, and the baby remained under close supervision of the neonatology team. Pediatric surgical team was involved in the management and that surgery was undertaken within an appropriate medical timeframe based on clinical indications. With respect to the surgery performed on 29.10.2024, it is contended, intra-operatively, necrosis was confined to the large bowel and that maximum bowel length was preserved. Avulsion of right kidney was an extremely rare and unforeseen intra- operative complication arising due to severe NEC-related adhesions and friable tissues in an extremely low birth weight and growth-restricted infant. Respondents deny that the kidney was intentionally removed and assert that the avulsion occurred during blunt dissection and not due to any negligence. 2.6. The intra-operative complication was promptly disclosed to the family members and attendants. Petitioner No.3, who is a general surgeon, was invited into the operation theatre and was shown the intra-operative findings, demonstrating transparency in the management. Respondents categorically deny the allegations of organ harvesting or malicious intent and contend that such allegations are baseless, scandalous and defamatory. It is further contended that all treatment decisions were taken in a transparent manner and explained to the family, and Petitioners were offered options for second opinions. It is asserted, the hospital follows stringent infection control policies and that recurrent infections in extremely low birth weight infants occur due to immunological immaturity rather than any lapse in aseptic precautions. Despite the high-risk nature of the case, the baby survived for nearly 90 days post-surgery, tolerated external feeds and did not suffer major neurological complications, reflecting the quality of care provided. 2.7. Respondents state that there was no deviation from accepted medical protocols, no breach of duty of care, and no mala fide intention on the part of Respondents 7 to 10.
2.7. Respondents state that there was no deviation from accepted medical protocols, no breach of duty of care, and no mala fide intention on the part of Respondents 7 to 10. The adverse outcome was a consequence of the baby's extreme prematurity and associated complications, and not attributable to any act of negligence or misconduct. In the above circumstances, they pray that Writ Petition be dismissed for want of maintainability, or in the alternative, Respondents 7 to 10 be deleted from the array of parties with exemplary costs for filing a false, frivolous and vexatious petition. 3. Heard Sri Md. Shabuddin, learned counsel for petitioners, learned Government Pleader for Medical, Health and Family Welfare and Ms. Jayanthi Talluri, learned counsel for Respondents 7 to 10. 4. The principal issue that arises for consideration is whether this Court, in exercise of extraordinary jurisdiction under Article 226 of the Constitution, can entertain and adjudicate the present Writ Petition which is founded on allegations of medical negligence against a private hospital and private medical professionals, involving seriously disputed questions of fact and expert medical opinion, and grant the substantive reliefs sought by the Petitioners. 5. It is well settled that jurisdiction of this Court under Article 226 is discretionary in nature and is ordinarily not exercised where the adjudication of the dispute requires resolution of complex and disputed questions of fact, particularly when such adjudication would necessitate appreciation of expert evidence, examination of medical records, evaluation of professional standards of care, and possibly cross- examination of witnesses. In the present case, the allegations raised by Petitioners span several stages of medical treatment, including antenatal care, interpretation of Doppler and ultrasound findings, timing and nature of obstetric intervention, neonatal intensive care management, diagnosis and management of necrotizing enterocolitis, timing of surgical intervention, and the intra-operative events leading to the removal of the right kidney of the infant. Each of these issues is contested by Respondents and is supported by rival versions, explanations and medical opinions. 6. Determination of these issues would necessarily require a detailed examination of medical literature, established protocols, operative notes, histopathological findings, expert testimony from specialists in obstetrics, neonatology, pediatric surgery and pediatric nephrology, and an assessment of whether the standard of care expected in such highly specialized medical circumstances was adhered to or breached. Such an exercise is plainly beyond the scope of summary adjudication under Article 226.
Such an exercise is plainly beyond the scope of summary adjudication under Article 226. Petitioners seek, inter alia, a direction for registration of FIR against Respondents 7 to 10, constitution of an independent medical board to enquire into the alleged negligence, initiation of disciplinary proceedings against the concerned doctors, and reimbursement of medical expenses allegedly incurred. Each of these reliefs is governed by a distinct statutory framework providing specific remedies and procedures. 7. Insofar as the grievance relating to non-registration of FIR is concerned, the Code of Criminal Procedure provides an efficacious mechanism, including remedies under Sections 154(3), 156(3) and 200, which Petitioners are entitled to invoke. Allegations of medical negligence coupled with claims for reimbursement or compensation fall within the jurisdiction of civil courts or consumer fora, which are equipped to conduct a full-fledged trial and assess evidence. Disciplinary action against medical professionals is statutorily entrusted to the State Medical Council or the National Medical Commission, which possess the requisite expertise and regulatory authority. 8. While this Court is conscious that the right to health and medical care is an integral facet of the right to life guaranteed under Article 21 of the Constitution, it is equally well-settled that not every allegation of medical negligence, particularly where it arises out of treatment rendered by private medical professionals in a private hospital, warrants invocation of writ jurisdiction. The extraordinary jurisdiction under Article 226 cannot be converted into a forum for adjudicating private medical disputes involving contested facts and expert opinion. 9. In the present case, Respondents 7 to 10 are private entities and private professionals. Petitioners have not been able to demonstrate that the said Respondents were discharging any statutory or sovereign public duty in the course of the treatment in question so as to render them amenable to writ jurisdiction for the reliefs sought. Nor have the Petitioners established that the alternate remedies available under law are either inefficacious or illusory. 10. With regard to the prayer seeking rejection of expert opinion obtained and constitution of an independent medical board, this Court is of the considered view that such matters fall squarely within the domain of forums competent to assess expert medical evidence after due process. This Court cannot substitute itself for a fact-finding or expert adjudicatory body, particularly in a matter involving highly specialized medical issues.
This Court cannot substitute itself for a fact-finding or expert adjudicatory body, particularly in a matter involving highly specialized medical issues. This Court, therefore, consciously refrains from expressing any opinion on the merits of the allegations of negligence, the explanations offered by Respondents, the correctness or otherwise of the expert opinion placed on record, or the rival medical theories advanced by the parties. All such issues are left open to be urged before and decided by the appropriate forum in accordance with law. 11. Accordingly, the Writ Petition is dismissed, giving liberty to Petitioners to avail such appropriate remedies as are available to them in accordance with law before the competent civil Court, consumer forum, or the statutory medical authorities, as the case may be. It is made clear that this Court has not expressed any opinion on the merits of the allegations levelled by the Petitioners or the defences raised by the Respondents, and all contentions of both sides are left open to be urged and adjudicated before the appropriate forum. No costs. 12. Consequently, the miscellaneous Applications, if any shall stand closed.