Hospital, Gynecologist slapped Rs 17.5 lakh for failing to detect foetal anomaly

Mumbai: Holding the Vidula Nursing Home and its gynecologist Dr Pradip Pawar guilty of negligence, the Maharashtra State Consumer Commission slapped a compensation of Rs 17.5 lakhs on account of failing to detect a fetal anomaly.

Case is of a couple who after being unable to conceive after five years of marriage came under the care of gynaecologist Dr Pradip Pawar in the month of March, 1998. After going certain treatments, in June 1998, the complainant became pregnant. During the course of her pregnancy, she complained of high BP, frequent spotting at the genital area and referred to the doctor at each point. At each event, ultrasound was performed on the patient and the doctor again and again assured her that there was nothing wrong with her pregnancy. A total of 7-8 ultrasounds were performed on her.

Nearing the time of the delivery, dissatisfied with Dr Pawar, the complainant decided to change her gynecologist and went under the care of Dr.Ranjeet Mehta who asked her to go through another sonography. Two sonographies were performed in March 1999 which revealed, the foetus in the womb had a defective spinal canal with irregularities, which is termed in medical Parlance as Meningomyelocoele. Being in the 37th week of her pregnancy, the patient could not go for abortion and soon delivered through a caesarean section. The child was subsequently confirmed to have severe spinal disorder. At present the child is 15 yrs old and though of good intelligence has had to suffer the major problem of being paralyzed waits downwards with poorly developed lower limbs.

Claiming medical negligence and deficiency in service on the part of Dr Pawar and other doctor of Vidula Nursing Home & Infertility Clinic, the complainant approached the consumer court.

During the court proceedings, the doctor denied being guilty of deficiency in service stating not all defects are detected during sonographies. The doctors relied on the affidavits of  2 radiologists experts Dr. Shivde and Dr. Chaubal who firmly opined that there is no medical negligence or deficiency in services pointing out the following

• All foetal anomalies may not always be visible due to technical difficulties related to foetal position, amniotic fluid [fluid around the foetus] volume and foetal movements. He has further stated that as the foetus grows in size the anatomic malformations like spinal abnormalities also grow in size and become detectable only at the end of pregnancy or at birth. Ultrasonic waves cannot travel through air and [ bones and hence intraspinal lesions like 'diestemetamyelia' are difficult to diagnose. Due to technical difficulties, negative prenatal ultrasonographic examination does not provide absolute assurance that a foetus is defect free.

• Evaluation of foetal anatomy is universally recognized as an integral part of obstetrical sonography. But the sensitivity of ultrasonography to detect abnormalities varies from as low as 16.6% to as high as 84.3% in various studies published worldwide...... foetal anomalies may not always be visible due to technical difficulties related to foetal position, amniotic fluid [fluid around the foetus] volume and foetal movements. Further it has been stated that, Ultrasonic waves cannot travel through air and bones and hence intraspinal lesions like 'diestemetamyelia' are difficult to diagnose

However, noting that Court is not bound by evidence of expert which is to a large extends in advisory in nature, the commission held Dr Pawar and the nursing home, guilty of medical negligence, asking them to compensate the complainants with Rs 17.5 lakhs.