Epidural Hematoma leading to paraplegia: Delhi HC upholds MCI suspension of Gynaecologist

New Delhi: Through a recent judgment, the Delhi High court upheld the Medical Council of India order calling for removal a gynecologist’s name from the Indian Medical Register for 15 days. This came after the council held her guilty of negligence in providing post-operative care to a patient after childbirth, which left her suffering from a permanent paraplegia. The Delhi High Court had upheld the said decision after the doctors challenged the MCI’s order.

The case concerns a patient, who was admitted for childbirth under the care of Dr Meena Harsinghani, a gynecologist and obstetrician by profession at Deepak Nursing Home. She was consulting Dr Meena since her pre-natal period.

After examination, the doctor informed the patient that the fetus had passed meconium in the uterus and that could be dangerous, as the fetus could breathe the meconium into his /her lungs. Therefore, she was rushed to the operation theatre in emergency.

As the anesthesiologists on the panel of the nursing home were not available, Dr Narayan Harsinghani, Dr Meena’s husband, an anesthesiologist administered anaesthesia in the spine of the patient. The patient delivered the baby without any further complications. However, she complained of severe pain in the back and heaviness in the lower part of her body.

She was examined on the next morning, which was around 14-15 hours after the operation. Subsequently, a consulting neurologist, Dr Nirmala Lahoti advised treatment including steroids and physiotherapy and advised an MRI in case of poor response to the steroids. The MRI showed that she had suffered from an epidural haematoma, a post-spinal anesthesia complication leaving the patient with permanent paraplegia.

Aggrieved with the fact that if the complication had been discovered at an earlier stage, she wouldn’t have suffered the paralysis, the patient filed a complaint with the Delhi Medical Council (DMC) alleging that after the delivery of the baby, neither the gynecologist nor the anesthetist checked her leg movement and sensation to ascertain whether power had come back. She stated that she had severe pain in her spine and thighs but the doctors took it very lightly.

After hearing the complaint, the Disciplinary Committee of DMC observed that the treating team failed to assess the gravity of the clinical condition of the complainant.

The committee concluded that the doctor couple had failed to exercise the reasonable degree of skill, knowledge, and care, as was expected of an ordinary prudent doctor, in the treatment administered to the patient at the Nursing Home. Accordingly, it recommended that the names of the petitioners be removed from the State Medical Register for a period of 15 days.

While observing the recommendation made by the committee, the DMC held, “In this case error of judgment constituted an act of medical negligence,” and directed the suspension. In response, the doctors moved the MCI, preferring an appeal against the said order.

Before the Ethics Committee of MCI, the doctors asserted that the patient had complained of the heaviness of limbs only in the morning of 29.11.2008. She was thereafter, examined by Dr Narayan, who found some movements in both the limbs. The doctors emphatically stated that Dr Lahoti had advised a conservative treatment and had not advised an MRI.

Dr Lahoti refuted the statement and reiterated that she was called for consultation about 18 hours after administration of anesthesia. “By that time the Complainant had already suffered maximum neurological damage,” she added. In addition, she alleged that the medical records had tampered.

After considering the submissions made by all the parties, the Ethics Committee of the MCI concluded,

“There was a gross delay in identifying & managing the complication of Epidural Hematoma on the part of Dr Narayan Harsinghani. The Neurological opinion was not sought promptly.

… Besides, Neurologist has also informed that there has been tampering of records and hence taking into account the above, the Ethics Committee is of the view that the name of Anesthestist, Dr. Narain Harsinghani, be removed from the IMR Register for a period of 3 months. The Ethics Committee also decided to uphold the decision of Delhi Medical Council in case of Dr. Meena Harsinghani.”

Once again, the doctors went against the order and moved the Delhi High Court. During the hearing, the counsel appearing for the doctors contended that since Dr Lahoti had not advised MRI, they could not be faulted by not taking immediate steps for advising an MRI. It was also submitted that the doctors had no opportunity to counter the statements made by Dr Lahoti before the Ethics Committee as she had appeared before the Ethics Committee at a meeting held after the doctors had been heard.

Considering all the submissions as well as previous orders, the bench of honourable Justice Vibhu Bakhru found no reasib to doubt to the finding of DMC as well as the MCI, which stated, “the initial period of 12 to 13 hours was crucial and the patient had a better chance of recovery if she was taken to surgery within that period.”

 The court, in its observation stated that it found no reason to interfere with their decisions.

The court, in its conclusion, noted that the doctors should have reacted in a timely manner and recognized the gravity of the problem at an earlier stage. While disposing of the plea, the HC upheld the punitive measure against Dr Meena ,however, set aside the enhancement of punishment of Dr Narayan.