Anaesthesia administered twice to caesarean patient: Kamineni hospital Telangana slapped Rs 1 crore compensation

"The Opposite Party No.5 hospital is vicariously liable for the acts of the Opposite Parties (doctors) who failed in their duties," the court noted.

"In the instant case, the Opposite Parties No.1 to 4 (2 gynaecologists, Senior resident anaesthesia and emergency medicine doctor) were duty bound to treat the patient with reasonable degree of skill, care, but they failed to exercise due care and diligence, which constitutes medical negligence," the Commission held while directing to hospital to pay Rs 1 crore as compensation to the family.

"In the result, the complaint is allowed in part, directing the Opposite Party No.5 Hospital, i.e. Kamineni Institute of Medical Sciences Hospital, Nalgonda to pay Rs.100,00,000/- [Rupees One Crore only] towards compensation and Rs.1,00,000/- [Rupees One Lakh only] towards litigation costs to the Complainant No.1 and the GPA Holder. i) Out of the awarded compensation, an amount of Rs.90,00,000/- [Rupees Ninety Lakhs only] shall be fixed deposited in any Nationalized Bank in the name of Asnala Devansh Showrya, i.e. Complainant No.1 until he attains majority. The GPA Holder can withdraw periodic interest for care and welfare of the child. ii) The remaining compensation amount of Rs.10,00,000/- [Rupees Ten Lakhs only] shall be paid to the GPA Holder," ordered the Commission. It also allowed Rs 1 lakh as costs of litigation, which shall be paid to the GPA Holder.

Case History: 

During her pregnancy, the patient was under complete medical observation under the supervision of the doctors in the treating hospital. She was informed that both the patient and the fetus were in good condition. In July 2018, the consulting doctor advised to deliver the baby via C-section.

To perform the C-Section (Caesarean) surgery, the Anaesthesia Senior Resident administered anaesthesia to the patient in the presence of other Junior Doctors. The said surgery was done at about 10:55 to 11:00 p.m. a male baby was delivered out of the said surgery by the doctors.

The patient was shifted to the post-operative ward. However, the patient was still unconscious. When the complainants questioned why the patienty was still unconscious, one of the doctors allegedly informed that while doing the stitches after C-Section, the patient regained consciousness and not allowing them to complete the sutures, hence anesthesia was administered once again for a second time.

However, the patient did not regain consciousness, and there was heavy bleeding as well. Even though arrangements for blood transfusion were made, it could not be done. Some more time passed, and the patient expired.

The complainants alleged that the patient died only due to the negligent acts of the hospital and the doctors. There was a failure to exercise proper post-operative care, the emergency doctor was not available round the clock, there was an improper monitoring of C-section, resulting in blood clotting, stoppage of urine, and not regaining consciousness and anaesthesia was administered twice, resulting in heavy blood loss, leading to the patient's death. They also alleged that the patient died from an overdose of anaesthesia.

On the other hand, the treating hospital and the doctors submitted that the patient came to the hospital with term gestation of the first pregnancy with gestational hypertension, with hypothyroidism, underwent emergency lower segment caesarean section for failed induction and fetal distress under spinal anesthesia which was supplemented by general anesthesia. Patient was reintubated in view of respiratory distress and put on mechanical ventilator. Subsequently patient developed hypotension which was managed by IV Fluids and vasopressors. ECG showed S1Q3T3 pattern suggestive of pulmonary embolism, 2-D ECHO showed global hypokinesia, moderate to severe left ventricular dysfunction suggestive of peripartum cardiomyopathy. Elevated PT and APTT suggested Disseminated Intravascular Coagulation. Pulmonary Embolism and Peripartum cardiomyopathy resulted in refractory hypotension and cardiac arrest.

They also submitted that the risk of thromboembolism in pregnancy and post-partum period is 0.5% to 3%. Incidence of thromboembolism in pregnancy is 7 to 10 times higher than in non-pregnant women, where as it is 15 to 35 times higher in post-partum period. Pulmonary embolism is fatal in almost 15% of the patients, and 66% of deaths occur within 30 min of embolic event. Deep venous thrombosis is often unnoticed in pregnancy and postpartum period. Thus it usually presents with dreaded complication that is pulmonary embolism. Pulmonary thromboembolism with hypotension and right ventricular dyskinesia has high mortality. Peripartum cardiomyopathy commonly occurs in primigravida. The symptoms appear predominantly in post-partum period in 70-80% of cases. The mortality rates of peripartum cardiomyopathy are 18-50%. The combination of pulmonary embolism and Peripartum cardiomyopathy significantly increases the maternal mortality rate. The hospital and doctors denied all allegations of medical negligence.

They also filed the decision of the Medical Council. After going through the enquiry report submitted by the complainants, the Ethics Committee of the Council noted that there was no negligence on the part of the treating doctors. 

Consumer Court Observations: 

While considering the matter, the consumer court perused the case summary and noted that the immediate cause of death was due to Refractory hypotension with severe metabolic acidosis with severe coagulopathy, the antecedent cause is due to cardiogenic shock with pericardial tamponade with presence of amniotic fluid/Thromboembolism.

"Thus, the above factors were not managed and Opposite Parties No.1 to 5 have failed to give right treatment in order to save the patient. It is only due to sheer negligence and improper treatment that *** had lost her life," observed the Commission.

It also observed that the treating doctor had administered anaesthesia twice, i.e. spinal anesthesia and other general anesthesia, which is against the protocol of C-Section delivery. In this regard, the Commission observed,

"Generally, anesthesia is regional like spinal or epidural, to numb the lower part of the body, but in the instant case, there is overdose of anesthesia that the patient did not regain conscious for more than 24 hours and Opposite Party No.3 (SR Anaesthesia) administered anesthesia without knowing the condition of the patient nor verifying from other doctors‟ notes. As such, it proves that there is no coordination between the doctors in treating the patient."

Regarding the Medical Council's order, the Commission observed,

"The finding of the Ethics Committee is only an advisory nature, but not expert opinion. As such, the report of Ethics Committee cannot be considered and believed. There is clear findings with regard to discrepancies of the Casesheet and PME Report. Thus, the principle of res-ipso-loquitor is applicable as the record itself speaks about the negligence and improper treatment given by the Opposite Parties No.1 to 4 (the doctors) of Opposite Party No.5 hospital, as there were variations in findings in P.M.E. Report and in the Chargesheet."

Referring to legal precedent, the Commission noted,

"The above citations are relevant and applicable to the present facts of the case. In the instant case, the Opposite Parties No.1 to 4 were duty bound to treat the patient with reasonable degree of skill, care, but they failed to exercise due care and diligence, which constitutes medical negligence. It is evident that the patient treated with ventilators, but Opposite Parties have ignored the possibility of pulmonary embolism and the findings in case sheet are contrary to the PME Report, showing massive broad ligament hematoma and hematoma below the rectus sheath. The administering of anesthesia twice to the patient also gave rise to high risk in causing the death of the patient. Therefore, Opposite Parties have failed to treat the patient according to the medical protocol and due to the negligence, ***, a 23 years old young woman lost her precious life leaving behind minor son, i.e. Complainant No.1 and her husband, i.e. Complainant No.2 and her father, i.e. GPA Holder."

Accordingly, the District Consumer Court held that "the Complainants are entitled for compensation of Rs.1,00,00,000/- along with costs."

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/dcdrc-kamineni-hospital-307994.pdf

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