Death of Pregnant Woman, Unborn Child: NCDRC holds Bengaluru Hospital, Anesthetist Guilty of Medical Negligence, Orders Rs 1.6 crore compensation

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) has directed a Bengaluru-based hospital and its Anesthetist to pay altogether Rs 1.6 crore compensation to the family members of a patient, who died while undergoing Caesarean Section along with her unborn baby.

While the hospital and the treating doctors claimed that the death of the patient happened due to anaphylactic reaction, the top consumer court disagreed with this opinion. Relying upon the Post Mortem findings and expert opinions, the NCDRC bench observed that the patient died due to hemorrhagic shock which could be only due to trauma inside the OT.

"Based on the foregoing discussion we determine ‘medical negligence’ and ‘deficiency’ on the part of the OP-1 hospital and the OP-3 anesthetist. The OP-3 conclusively failed to prove the theory of Sodium Pentothal anaphylaxis. It was traumatic injury to the SI joint of the full term pregnant woman who was inside the OT. The PM findings and the evidence/opinions of experts conclusively establish the death of patient and the foetus was due to fall in the OT and subsequently the hemorrhagic shock, but conspicuously the OP-3 portrayed it as Anaphylactic shock to the Pentothal. It was very unfortunate and sad to note that two precious lives were lost - the young Primigravida and also her fetus," the Commission observed.

"In view of the peculiarity of this case, to meet the ends of justice, we allow the lumpsum compensation of Rs. 1.6 Crore to be just and adequate. The OP-1 hospital shall pay Rs. 1.5 Crore and the OP-3 Anaesthetist shall pay Rs.10 lakh to the Complainants. We do not find either negligence or failure of duty of care from the Obstetrician, thus OP-2 is exonerated. We also allow Rs. 2 lakh towards the cost of litigation," it ordered.

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The history of the case goes back to 2010 when the patient was pregnant and consulted the Senior Gynecologist at Santosh Hospital. After being advised for C-Section delivery, the husband of the patient took her to the Hospital on the fixed date for the surgery. Allegedly, the patient had informed the treating doctor about her allergy to Sulpha drugs and her congenital birth defect. For the C-section procedure, the Anesthetist Dr. P Ashok decided on General Anesthesia.

After taking the patient into the Operation Theater, the treating doctor informed the complainant that the patient was given GA and one-in-a million patient may react violently to the drug. Further, the complainant was informed by the doctor that due to severe ‘Anaphylactic shock’ from Sodium Pentothal (anesthetic agent), the condition of the patient became very critical and the doctors were trying their level best to revive her and shifted to ICU. Allegedly, the treating doctor claimed that she had not even touched the patient. However, within less than one hour of shifting the patient to the ICU, both the patient and the unborn child had been declared to be dead. 

The complainant alleged that the doctor did not try to assess the condition of the baby and failed to save the baby with the help of surgery. Further, it was alleged by the Complainant that his wife died in the O.T. However, to cover-up their negligence, the doctors tried to show it as shifted to ICU. The Complainant claimed that the the ICU monitor showed zero reading, which itself confirms that the patient and unborn child were already expired in the OT. Further it was alleged that the treating doctor made casual attempt to note Foetal Heart Sound (FHS) on the dead body and even the USG was actually done 15 minutes after the death.

Consequently, a police complaint was filed and Post Mortem was performed on the patient. The cause of death mentioned in the intimation letter was "cardio respiratory arrest seconding to acute anaphylaxis reaction". Meanwhile, the Post Mortem report recorded that there were-

a. Fracture of the Left Sacroiliac joint and plenty of clots into muscles in front of the joint.

b. Peritoneal cavity contained 1500 gms of clot and 200 ml of fluid blood.

c. The mesentery (mesocolon), transverse and left mesocolon were contused.

The FSL report received on 27.05.2010 revealed the anesthetic drug Thiopentone was not present in detectable limits. In the final PM report, the cause of death was given as 'shock and hemorrhage as a result of the injury to the pelvis sustained'.

After receiving the Preliminary PM report, a further FIR was lodged and a a case of medical negligence CR158/2010 under sections 304A, 315 and 201 of IPC was registered by Pulakeshinagar Police Station, Bangalore. The Crime Investigation Department (C.I.D), Karnataka took over the investigations in August 2010 and after 9 months of investigations filed a charge-sheet under sections 304A, 315, 201 r/w 34 of the IPC making OP-2, OP-3, & other accused staff. Further, the concerned case has been committed to the Court of Session and is being tired in Fast Track Court in Bangalore. Even though the criminal prosecution had been challenged by the doctors, the Supreme Court upheld the same.

Meanwhile, the Complainant also filed a complaint in the Karnataka Medical Council against the doctors for professional misconduct and malpractice and filed the Consumer Complaint before NCDRC for alleged medical negligence.

The hospital and the doctors denied negligence on their part and the treating Gynaecologist submitted that since the patient had spinal problem, epidual anesthesia was avoided. Therefore, GA was preferred for elective LSCS. She further submitted that when she started painting the abdomen of the patient with Povidone, the Anesthetist noticed the appearance of allergic rashes which were increasing. The allergic reaction was treated by the Anesthetist and he gave IV Efcorlin 200 mg intravenously. Following this, the Anesthetist told her not to proceed for surgery because he noticed bradycardia, hypotension and fall of oxygen saturation. It was diagnosed as severe Anaphylactic shock due to the anesthetic drug – Thiopentol sodium which occurred before the commencement of surgery.

The Anesthetist informed the bench about the medical records and submitted that resuscitation efforts had been made to revive the patient. He submitted that as per histopathology report, the patient had right ventricular dysplasia, which could be the reason for unsuccessful resuscitation. The anaphylactic reaction (Grade IV) led to patient pulseless and cardiac arrest.

After taking note of the submissions by both the parties, the top consumer court also considered the report of the Expert Committee constituted by Bangalore Medical College and Research Institute (BMCRI). The expert panel opined, "After having gone through the records and the post mortem report, the fracture of the SI bone with a hematoma on the left side, can occur following a trauma. This can also cause hemorrhage."

"The presence of blood clots (1500 ml), haemo peritoneum (200 ml) contusion to the transverse colon and to the left mesocolon, and associated perinephric collection, can be due to trauma, and the cause of death due to hemorrhagic shock," it further noted.

Further referring to relevant medical literature, the NCDRC bench noted that the complainants alleged that the patient died due to fall from the operation table which sustained fracture of SI joint leading to hemorrhagic shock and death. On the other hand, the doctors claimed that it was due to severe anaphylactic reaction to the anesthetic drug sodium pentathol, which subsequently led to cardiac arrest and death.

"However, we are not convinced with the submission of the OPs about the anaphylactic reaction. The question before us that why there was massive blood clots and intra-peritoneal bleed, if it was an anaphylactic drug reaction. Such bleed could occur due to fall or any blunt trauma to the internal organs. We do not accept that anaphylactic reaction by any stretch of imagination will not cause such traumatic hemorrhage. At the full term pregnancy due increased vascularity in the venous plexus the pelvic bones of the woman are more vascular and fragile. Any trauma may lead to vascular injury and severe bleeding," observed the Apex consumer court.

"It is evident from the available medical records the OPs were trying to establish the story of anaphylaxis. The report of CFSL, Hyderabad clearly establishes that the OPs deleted the readings of OT Monitor, ICU Monitor and the Digital copy of USG. It was an attempt of OPs who tried to destroy the evidence. Thus, it was unethical practice," it further noted.

Relying on medical literature and referring to the Supreme Court order in the case of Jacob Mathew, the NCDRC bench held the Anesthetist guilty of negligence and observed,

"In the instant case, the death of patient and her foetus was due to the negligence of the hospital and the OP-3. However, prima facie we do not find any negligence of the OP-2 who did not start any operative procedure (Caesarean). Moreover, during resuscitation, the prime aim was to save the mother therefore the team of doctors were focused on resuscitation. In addition to trauma, umbilical was cord around the neck of foetus caused death. Therefore, the baby could not be saved; it was not a negligence of OP-2 or the team in OT. It is pertinent to note that the patient was under custody of doctors and the OT staff, but she sustained left SI joint fracture and suffered hemorrhagic shock resulted into death of the patient. As discussed above and from the PM findings, the death was not due to anaphylactic reaction. The OP-3 Anesthetist failed to establish why there was large amount of peritoneal / pelvic hemorrhage, whether it was due to anaphylactic reaction."

Opining that the hospital was vicariously liable, the bench further noted,

"Thus hospital (OP-1) cannot escape from its vicarious liability for the medical negligence that has been meted out in the present case. The hospital is required to compensate for the medical negligence and mental agony sustained by the patient’s family members."

With this observation, the Apex consumer court directed the hospital to pay Rs 1.5 crore as compensation to the family of the deceased patient and asked the Anesthetist to pay Rs 10 lakh to the complainants.

"We may observe that, in case if the Complainant No.1, the husband of deceased Kapali Patne, got re-married; the entire amount shall be paid to the parents of the deceased Kapali Patne. Order in entirety shall be complied by the OP-1 and 3 within 6 weeks from today, failing which, it shall carry the interest @ 7% per annum till its realisation," added the NCDRC bench.

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc-rs-15-crore-compensation-210949.pdf

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