Foetal Death due to cardiomyopathy: Hospital told to pay Rs 12 lakh compensation

New Delhi: Holding negligence on part of doctors and hospitals, in treatment of a pregnant woman, whose baby died during delivery due to cardiomyopathy, the National Consumer Disputes Redressal Commission has now directed Cosmopolitan Hospital and its two doctors to pay Rs 12 lakh to a patient

The case goes back to year 2008-09 when a first-time pregnant woman had come under the care of Cosmopolitan Hospital, Thiruvananthapuram and its doctors Subhardra Nair and Krishna Kumar PK. During the course of her pregnancy, she developed breathlessness and was prescribed certain medicines. However, despite medication, her breathing problems continued and she also started feeling inflammation (oedema) in her legs. She even got admitted for the treatment for the same. On 13.01.2009, as her labour symptoms had developed, caesarian operation was performed. The Anesthetist examined the Patient and, as per his direction, the Doctors referred the Patient to a Cardiologist, who advised certain tests. At that time, the Doctors disclosed that the child in the womb had died on 12.01.2009 due to dilated cardiomyopathy and referred the Patient to KIMS Hospital, Thiruvananthapuram on the ground of lack of facilities in the Appellant/Hospital. The patient was treated in KIMS Hospital as an inpatient from 13.01.2009 to 05.03.2009 and from 11.03.2009 onwards and underwent a surgical operation, dialysis etc.

Alleging negligence, the patient filed a complaint against the doctors and the hospital.

The doctors and the hospital denied any negligence before the forum. It is averred that caesarian operation was considered necessary because the Patient had started leaking and the Cervix was not favourable for a normal delivery and as the necessary facilities were not available with the Appellant Hospital, the Patient was referred to KIMS. Further, it is averred that if the Patient had complained of breathlessness and inflammation, she would have been advised hospitalization. But, the Patient had reported in the Hospital only on 01.01.2009, complaining breathlessness, inability to lie down even for a short period, and accordingly she was advised admission by the Treating Doctors. While in the Appellant Hospital, the Patient had been attended to by the Physician, the Gynaecologist and the Pulmonologist.

As regards Caesarian Operation, it was felt that it should not be attempted at that time because the baby was too premature for removal and if caesarian section was done on a patient with respiratory problems, it would aggravate the condition and could prove fatal. On 13.01.2009, in view of the Patient’s condition, the caesarian section was considered necessary. Prior to the said procedure, the Patient was examined by the Anesthetist and Cardiologist. The Echo test showed that she had Cardiomyopathy and the aforesaid procedure should be conducted with ventilator support. Since the said facility was not available in the Appellant Hospital, the Patient was transferred to KIMS Hospital.

Their submission added that the foetal cardiogram showed movements and foetal heart was recorded till 11.25 AM as normal (132/min), when the Patient was shifted to KIMS Hospital The statement that Opposite Party No.2 had disclosed that the child in the womb had died on 12.01.2009 was a false statement.

All the allegations regarding lack of proper diagnosis, wrong diagnosis, negligence etc. are denied. It is pleaded that the Patient had a serious condition, Cardiomyopathy, which would require expert and often elaborate procedures over a period of time. Peripartum Cardiomyopathy is occasionally seen in the last month of pregnancy or two weeks after delivery. It cannot be diagnosed early and diagnosis can be made only when it occurs. Therefore, the Complaint was liable to be dismissed.

The state commission took note of the Medical Board's submissions which deny negligence on the part of the doctors but opined that chest X-ray and cardiac evaluation could have been done earlier. The state commission hence allowed the appeal and directed Rs 12 lakh compensation

Challenging the same, the hospital filed an appeal with NCDRC. NCDRC noted that brief point for consideration is whether there was any negligence on behalf of the Appellants in treating the Patient and the same has to be tested on the touch stone of the ‘duty of care’ and ‘standard of care’ which ought to be exhibited by the treating doctors as laid down by the Hon’ble Supreme Court in a catena of judgements.

The forum noted From the medical records, it is seen that the Patient a pregnant lady being treated by the Appellants herein right since inception of the pregnancy, was diagnosed to be an asthmatic patient and was treated accordingly by consulting Pulmonologist Dr. P. Raveendran. The prescriptions evidence that the Patient have no significant relief from breathlessness despite treatment with Bronchodilator. It is an admitted fact that as on 13.01.2009, when the Patient was planned for emergency Caesarian Section, the foetal condition was good and only during pre-operative anesthetic evaluation, the anesthetist suggested ECG and cardiac evaluation.

She was treated with the relevant medicines and referred to a higher center with ICU facility as the cardiologist had diagnosed a block on the ECG and the ECHO done by him showed dilated Cardiomyopathy with poor LV function. It is the Appellants case that Peripartum Cardiomyopathy is a very rare disease and cannot be diagnosed in the first instance and when a pregnant lady having several hormonal changes together with a history of asthma it cannot be said that the standard protocol of ECG and cardiac evaluation ought to have been done at a prior stage i.e. prior to the pre-anesthetic evaluation

The forum then went in detail Doctor’s prescriptions and medical record during the hospitalisation and noted

From the aforenoted medical record it is clear that on 07.01.2009, when the Patient was seen, it is noted that there was history of wheezing of about three months. In fact, it has been clearly noted that the Patient did not have any previous history of Asthma. On 08.01.2009 wheezing continued which was referred to a Pulmonologist. Than on 10.01.2009, the Patient complained of tiredness and sleep disturbance which continued on 11.01.2009 and 12.01.2009. She was reviewed on 12.01.2009 by Dr. Raveendran, it is seen that the Patient continued to be restless and irritated and at 9.30 pm on 12.01.2009 there was clear recording that chest wheezing. Even at that point of time treating Doctors did not advise any chest X-ray or cardiac evaluation. When a pregnant patient was continually complaining of breathlessness the doctors ought to have done an ECG, which is a basic standard protocol at a prior stage.

The court went through the opinion of the medical board and concluded negligence on part of the doctors

As can be seen from the opinion given by the Medical Board, Peripartum Cardiomyopathy is a serious cardiac condition with high maternal and foetal mortality. Though any medical negligence has been refuted by the Medical Board on the part of the Gynecologist and the Physician, the Board has however opined that the chest X-ray and cardiac evaluation could have been sought for earlier . The Patient was admittedly not a high risk Patient at the time of admission in the Hospital, the foetal heart beat was good and had the Appellant sought for a chest X-ray and cardiac evaluation at an earlier stage perhaps the baby could have been saved. Though we accept the contention of the learned Counsel for the Appellants that extensive tests and procedure are never conducted at the very inception, however, in the instant case, it is noted that ECG is not an extensive test or procedure and it is a most basic test, which is considered as standard protocol in a situation where the pregnant woman was in the last stages of pregnancy and continuously complained of breathlessness. Hence, we are of the view that the Appellants and treating doctors were negligent in not performing a cardiac evaluation at the earlier stage, which could have prevented the loss of the baby and also the subsequent treatment

The court then held the decision of the state commission directing Rs 12 lakh compensation but waived the interest. NCDRC noted in its order that the findings of the Commission will not have any effect on the two doctors' career.

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