Medical complications cannot always lead to inference of medical negligence: NCDRC relief to Doctor

Rohtak: The National Consumer Disputes Redressal Forum has dismissed the complaint on the ground of that there was no negligence on the part of the doctor in providing treatment to a patient during delivery.

The case goes back to the year 2005 when a pregnancy lady was admitted to Sangwan Clinic for delivery in 31^st December 2005, owned by the treating doctor Rajendro Sangwan.

The patient underwent a normal delivery and gave birth to a male child. However, the placenta did not come out so the doctor first administered an injection and  the Treating Doctor then pressed the stomach of the Patient with great force and only on account of the excessive pressure administered, that the placenta along-with uterus had come out.

The Patient’s condition however deteriorated. Dr Hooda was called to see the Patient and when the said doctor saw the condition of the patient, she immediately advised the complainant to take her to PGI Rohtak. Then Complainant immediately took the Patient to PGI Rohtak and despite their best efforts, the doctors at PGI could not save the life of the patient.

The complainant approached the police station to file an FIR against the doctor. The application was then sent to PGI Rohtak to constitute a Board of Doctors for giving opinion on the matter. After obtaining the doctors’ opinion, the application was moved to the SP Head Quarter Rohtak and it was a prima facie case under Section 304-A, IPC and an FIR was registered against the treating doctor.

The doctor was arrested and during an investigation, the statements of 16 witnesses were recorded. It was averred that charges were framed under IPC Section 304-A and the case was posted for hearing.

Besides, the Complainant approached the State Commission seeking compensation of 25,00,000/- on account of the death of his wife who was also the mother of three minor children.

The State Commission went through the entire matter, but dismissed. Hence appeal was filed with NCDRC

The complainant contended that it was only because of the negligence of the treating doctor in not conducting the delivery hygienically, that the patient had developed post-delivery infection; that placenta was not expelled out but was retained; that expulsion has to be done under general anaesthesia for which there was no arrangement in the clinic and that the Medical Board had clearly stated that the attending doctor should have been able to detect and manage the complication at the same sitting by immediate reposition of the inverted uterus before referring the patient for further management and the State Commission has erred in not taking this into consideration. He further contended that in the deposition before the police Dr Hooda had clearly stated that the patient was in a deteriorated condition at the time of discharge.

The treating doctor drafted his version of the matter where he mentioned that the lady was a case of grand multipara. It was her 7^th pregnancy. However, the patient was brought to the treating doctor for the first time. He mentioned that the woman was initially treated by local dai who mishandled and mismanaged the case and thereafter the Patient had come to the Treating Doctor’s clinic. She  was brought in a state of emergency at midnight as the case of full-term normal delivery in the third stage and the doctor had attended as per the guidelines of medical ethics and a healthy male baby was delivered after an hour  but unfortunately the placenta was retained which is a known complication in the third stage of labour; another doctor was consulted and the case was referred to further management to PGI Rohtak within half an hour of the delivery and, therefore, there was no negligence on their behalf.

The doctor further mentioned that the patient was taken somewhere else instead of PGI where the inversion of the uterus had occurred. The patient was taken after a gap of one and half hours from the time of reference whereas the distance from the nursing home to PGI Rohtak was 22 km which requires 25 to 30 minutes via four-wheeler. The watchful expectancy period for coming out of placenta is 30 minutes. In the instant case, it was averred that the treating doctor had waited for about 20 minutes for the placenta to come out but it was still retained. It was specifically pleaded that there was no inversion of the uterus and the patient was referred to PGI. It was stated that the complainant should have got the post-mortem done which would have given the exact reason for the cause of death.

Dr Hooda, during her deposition, stated that the patient’s condition deteriorated as the placenta had not come out. It pleaded that it is only on account of negligence in the treatment rendered by the treating doctor that the patient had expired.

Dr Hooda mentioned that it was only because of wastage of one precious hour that the condition of the patient further deteriorated. The fixing of the responsibility of inversion of the uterus on the treating doctor by the Board of Doctors of PGI was totally baseless and the opinion given does not mention the name of the clinic or the doctor. Retained placenta at the third stage of labour is a known complication especially in a case where there were three abortions and deliveries, wherein, the atonicity of uterus increases and, therefore, the chances of retention of placenta increases. It is denied uterus inversion is a general complication in the third stage of delivery.

It was further mentioned that the patient was a multipara case and that atonic uterus is one of the common predisposing factors of retained placenta. The original expectancy period of retention of placenta is usually 30 minutes and in this case the treating doctor had watched for 20 minutes and, therefore, there is no negligence in rendering any treatment on her behalf.

The Consumer forum during the procedure referred to the previous judgment given in this regard. The State Commission dismissed the case and mentioned that-

Merely, the doctor failed to cure the disease, cannot be a case of medical negligence or deficiency in service. It is also settled law that medical complications cannot always lead to inference of medical negligence.

The matter was then taken to the National Consumer Redressal Forum. It too went through the entire case and upheld the decision taken by the State forum.

The commission stated,

We are of the considered view that in the instant case the treating doctor has administered the ‘duty of care’ as defined by law adhering to the standards of normal medical practices.

The Consumer Court dismissed the appeal. It state

At the cost of repetition, having regard to the Patient’s history of multiple deliveries and abortions, that the patient had gone to the clinic of the treating doctor for the first time in the middle of the night as an emergency, that the treating doctor had facilitated delivery of a healthy male baby and referred the patient to a higher management centre only because she did not have the facility of general anaesthesia especially keeping in view that the same has been also evidenced by the medical literature filed, that the treating doctor had adhered to the normal standards of medical practice in waiting for a period of 20 minutes for expulsion of placenta, we are of the considered opinion that there is no negligence on the part of the treating doctor and we do not find any illegality or infirmity in the order of the State Commission. Hence this appeal is dismissed. No order as to costs.