Birth Deformity missed in Ultrasound: Rainbow Hospital, Doctors told to pay Rs 5 lakh compensation

Telegana: A district consumer forum in the state has directed Rainbow hospital and its doctors to pay a lump sum compensation of Rs.5,00,000/- together with costs of Rs.5,000/- to the family of  a patient, on account of  not detecting the congenital deformity of the baby in prenatal ultrasounds

The case is that of a pregnant patient who went to Rainbow Hospital for periodical obstretic checkup and examinations and had prenatal scanning for four times on the advice of gynaecologist

The first prenatal screening/scanning report dated 14.03.2012 was issued by opposite party no.4 stating that it was normal; the second scan report dated 20.04.2012 was issued clearly informing that both hands were visible. In the third scan report dated 06.06.2012 was issued clearly stating that “ no obvious fetal structural defects” were observed. The fourth scan report dated 31.08.2012 was issued stating that there was “good interval growth”. All the reports of scanning were shown as normal without any medical problem to the patient and to her baby in the womb. After this, she underwent delivery at the hospital and to her shock, she gave birth to a child, who did not have right forearm distal to elbow joint (RT trans Radial amputation (Congenital))

Alleging negligence on the part of the doctors and hospital the patient stated that had opposite parties diagnosed the deformity of the right hand of the infant during the prenatal scan reports through necessary surgical intervention the deformity could have been rectified. Due to a deficiency in service rendered by the opposite parties all the complainants have been put to serious inconvenience, hardship and mental agony apart from irreparable financial loss. The family demanded a compensation of Rs 99 lakh, 67 thousand approx

The doctors and hospital denied any negligence. The response gave a detailed explanation of the scans done along with their purpose adding Antenatal scans of living and moving fetuses have limitations to accuracy. It is due to these limitations most scan centers attach long disclaimers at the end of the scans such as “all fetal abnormalities cannot be picked up by ultrasound scans. Detection of fetal anomalies depends on fetal position, penetration of ultrasound waves through maternal abdomen, gestational age of the fetus etc. Some abnormalities develop as the fetus grows and some congenital problems present only postnatal”. Technical limitation of the scan cannot be equated to negligence by the doctors/opposite parties

The gynecologist cited  BJOG: An International Journal of Obstetrics and Gynacology, October 2005 saying

“ The proportion of limb defects diagnosed prenatally remained low, particularly for amputation, where in three out of four affected babies it was unsuspected even in the most recent cohort. It can be very difficult for parents to understand how something as apparently obvious as a missing limb can be missed by a technique that readily detects brain and heart malformations in utero”.

Thus, the non-detection is not due to any omission of the doctors but due to a false
negative in the ultrasound reports.

Their response added that there are no treatments which can be done before the birth of the child/in the fetal stage and the complainants could not have done anything differently if the scan reports had stated the amputation of the right forearm.There is no way that the defect could be rectified in the pre-natal stage as a forearm cannot be created and transplanted in a fetus. If the problem/defect would have been diagnosed antenatal, it is a possibility that the complainants would have perhaps opted to discontinue the pregnancy to avoid the costs of rehabilitating a child for a condition which can be managed through rehabilitation.

Hence, the doctors and the hospital prayed for dismissal of the complaint.

The Gynaecologist in her cross examination stated that the deformity of the infant i.e., absence of right forearm distal to elbow joint can be amniotic band syndrome and explained the Amniotic Band Syndrome as it is an amniotic sac very rarely a band can form and can strangulate the small parts of body which in turn can decrease the blood supply to that part and later that part disappears.

The court at length highlighted the literature on Amniotic Band Syndrome and quoted the following

More severe cases may be considered for fetal surgery provided the maternal and fetal
risks of surgery are small. A full evaluation is required before going ahead with fetal
surgery as each case of amniotic band syndrome is unique and additional complications may be present. Fetal surgery may be a treatment option in select cases. This can be offered when the band is around a limb and causing swelling and obstructing blood flow to the limb. The fetal surgeons can enter the uterus with a small instrument and attempt to cut the band around the limb. This can be accomplished by either disrupting the band with a laser or cutting the band with a sharp instrument.

Observing from the above, that the child deformity could have been rectified Had the opposite doctors diagnosed the deformity in the foetus, there is a possibility of fetal surgery to rectify the deformity. Further holding that all the doctors of Rainbow Hospital who were concerned with the case, were qualified, well trained specialists and the hospital having state of the art technology why cannot they detect the deformity in the antenatal scan if they are really pioneers in the fetal medicine, the court held that Failure to detect abnormality in the fetus during pregnancy, thus constitute medical negligence amounting to deficiency in service on the part of opposite parties.

Coming to the compensation aspect the court observed that the complainants demanded a compensation of Rs.99,67,010/-. The court also observed that It is not sure that had the opposite parties detected the deformity they can rectify the problem successfully it is only a chance to get it rectify the deformity if they detected the deformity in the fetus. Therefore only 50% chance to the opposite parties to rectify the deformity as such the complainants are not entitled to the cost of Right Trans Radial Cosmetic Prosthesis with cosmetic glove as claimed by the complainant.

It is not that due to the negligence of the opposite parties during delivery of the complainant no.2, the child has become handicapped but it is only due to structural or functional abnormalities present at birth that cause physical or mental disability. Birth defects may be caused by genetic problems, problems with chromosomes, or environmental factors. The only negligence on the part of the opposite parties are that they did not detect the deformity in the fetus had they done it there is a chance of fetal surgery that might help the child in rectification of the deformity. Even after detection if the opposite parties failed in fetal surgery, the opposite parties also can counsel the parents to retain sufficient 'self-control'......

.Holding  negligence made by the opposite parties in not detecting the congenital deformity of the baby resulting the forum observed hat the complainants are entitled to lumpsum compensation of Rs.5,00,000/- together with costs of Rs.5,000/-.