Ectopic Pregnancy: State Forum overturns district forum order, absolves doctor of Medical Negligence

Kolkata: The West Bengal State Consumer Disputes Redressal Commission has given relief to a city-based doctor in a case of alleged medical negligence, overturning the decision of a lower forum that found guilty the doctor of negligence in providing treatment to a lady having an ectopic pregnancy

The case concerned a pregnant lady who was taken to one Dr Basu with a complaint of severe vaginal bleeding on 25^th February 2013. The treating doctor diagnosed it as incomplete abortion, therefore he performed Dilatation and Curettage ( D & C) under general anaesthesia (GA) in his clinic. The patient was discharged on the same day.

Post discharge, the patient complained of continuous abdominal pain and again on 12^th March she was taken to the doctor who after examination, advised for urgent Ultrasonography (USG) of the whole abdomen, TORCH test and  also prescribed some medicines

The patient, then, approached another doctor with the ultrasound report. The second doctor diagnosed that it was a ‘Ruptured Ectopic Pregnancy’ about size 37 X 23mm.

The patient was then taken to the third doctor at where he confirmed it as tubal pregnancy and performed Right Salpingectomy operation (removal of fallopian tube), but could not save the pregnancy.

Filing a complaint against Dr Basu the patient alleged that if the doctor had not conducted D & C, the baby (foetus) could have been saved. Being aggrieved by the alleged negligent treatment the husband filed a complaint before the District Forum.

When the accused doctor was asked for his version on the matter, he denied the allegations. It was submitted that, based on physical/clinical examination and USG report patient was diagnosed as a case of incomplete abortion. On the same day  D & C was performed. It was 4 weeks pregnancy and at that stage, USG did not detect ectopic pregnancy. Admittedly, it was detected on 16^th March i.e. at about seven weeks of pregnancy. As per the medical literature, the ectopic pregnancy can only be detected by USG only after six weeks of pregnancy. The doctor further submitted that the procedure of D&C was confined to uterine cavity only whereas ectopic pregnancy is outside the uterine cavity which commonly occurs in the fallopian tube. D & C is not a risk factor of ectopic pregnancy. The State Commission wrongly held that after D & C procedure pregnancy can’t retain/exist.

On the basis of pleadings and evidence, District Forum allowed the complaint and directed the opposite party to pay a total sum of Rs.2,31,380/- along with the cost of Rs.10,000/- to the complainant.

Being aggrieved, Dr Basu filed first appeal before the State Commission and it was dismissed. Against the impugned order, the doctor filed the instant revision petition.

The State Consumer Disputes Redressal Commission went through the details of the case and took a note against the medical text. The Court mentioned the causes, signs, symptoms and diagnosis of ectopic pregnancies.

The Forum stated-

We have gone through medical text which explained that an ectopic pregnancy occurs when a fertilized egg implants and grows outside the main cavity of the uterus. Ectopic pregnancy occurs in the fallopian tube in over 95% of cases is called Tubal pregnancy. In that most to occur is the ampulla (70.0%) then isthmus and the fimbria. Other locations for ectopic pregnancies are rare: abdominal, ovarian or cervical.

The court mentioned that detection by USG for ectopic pregnancy in early weeks (before 6 weeks) is very difficult. In some cases, the diagnosis of ectopic pregnancy can be made after a single measurement of HCG in combination with transvaginal ultrasound, if the HCG is above the discriminatory zone and transvaginal ultrasound shows no evidence of an intrauterine pregnancy and the presence of findings that suggest an ectopic pregnancy.

The court noted that-

We have given our thoughtful consideration to the arguments, the medical text from standard medical books (supra) and the documents on file. The main question to decide is whether there was deficiency in service from the OP to diagnosis the ectopic pregnancy or whether it was a misdiagnosis? According to the medical literature clinically and ultrasonologically early detection and ectopic pregnancy before six weeks is difficult. In the instant case, the patient had pain in abdomen and bleeding. USG report dated 25.2.2013 did not show evidence of ectopic pregnancy. The decision to perform D & C was taken by OP after proper investigations. In our view, OP treated the patient as standard reasonable practice. It is pertinent to note that, the ectopic pregnancy was detected after 7 th week of pregnancy. Therefore, in our considered view, it was neither deficiency nor a misdiagnosis from the OP.

The forum further added

It should be borne in mind that D & C performed by OP was for the bleeding/incomplete abortion, the procedure was only confined to uterine cavity. Thus, it is ridiculous to confer that because of D & C patient had developed tubal/ectopic pregnancy. It is medically impossible. We also note that, as a precaution the OP-doctor, after D & C advised antibiotics for 10 days and to detect cause of abortion TORCH test was advised. It was an accepted standard of care and practice in the instant case.

The court gave its decision on the matter giving relief to the doctor and setting aside the decisions of the lower fora

Based on the foregoing discussion, we do not find that OP committed either negligence or deviation from reasonable standard practice. Both the fora have erred to appreciate the concept of ectopic pregnancy and also the D&C procedure. We set aside the orders of both the fora below and allow this revision petition; consequently the complaint is dismissed.