Delay in C-section results in death of patient, newborn: Hospital, doctors slapped Rs 43 lakh compensation

Tuikhuahtlang: The State Consumer Disputes Redressal Commission recently directed a private hospital, its gynaecologist and anaesthetist to pay Rs 43 lakh as compensation to a man for medical negligence and breach of duty while providing treatment to his pregnant wife. After giving birth to a stillborn baby, the patient died and alleging negligence against the hospital, the complainant approached the Consumer Court. 

The matter goes back to 2016 when the patient was admitted to the treating hospital with a case of term pregnancy, without any health complications and her vitals were stable. 

However, the patient delivered a stillborn baby and died at the hospital. The complainant, the husband of the deceased patient, submitted that she was administered Injection Synto (Oxytocin) for more than 8 hours on admission to the hospital, and cervix examination was not done to ascertain whether cesarean delivery should have been performed and this resulted in the death of both the patient and the unborn child.

While the hospital alleged that the patient died due to an Amniotic Fluid Embolism (where the amniotic fluid enters the maternal circulation), the complainant alleged that the deceased and her child had died due to the negligence and breach of duty on the part of the hospital.

The counsel for the hospital submitted that three prerequisites to have amniotic fluid embolism syndrome were absent in the case summary of the patient. Referring to an online article, the complainant highlighted that symptoms such as shortness of breath, hypotension, shivering, coughing, vomiting were not present. 

Further, he highlighted that Injection Synto (Oxytocin) was administered and this fact was also seconded by another patient who was admitted to the hospital for delivery of the child at the same time. 

It was alleged that the patient was administered Injection Synto (Oxytocin) in excessive dosage to stimulate labour which ultimately resulted in severe complications leading to her death and the death of her female child. Filing the consumer complaint, the complainant demanded around Rs 98 lakh as compensation.

On the other hand, the hospital submitted its reply through Dr. Chhangte claiming that the shortness of breath was present so much in the patient that she had to be given artificial respiration. It was further submitted that shivering, coughing and vomiting were not present because the patient collapsed immediately within a minute.

The hospital further submitted that the explanation of the Doctor clearly stated the timing and subsequent dosing of oxytocin with standard medical textbook quotes and further claimed that the discharge summary may miss some of the events as it is only a summary. However, all these events were allegedly recorded by the nurses in their reports. Also, it was submitted that the use of syntocinon is not a critical event as the dose of syntocinon is as per protocol and well within normal limits.

While considering the matter, the Commission perused the available medical records and considered the arguments by both parties. The Complainant produced a medical expert as a witness. However, the expert informed that there were no procedural lapse on the treatment provided by the hospital and the treatment given by the doctors was good.

However, referring to the witness of the expert, the Consumer Court observed,

"We are of considered view that just by looking at the medical document, as stated by the witness himself, would not be suffice to conclude whether there were treatment procedural lapse in the instant case. He also admitted that Injection Synto is a powerful drug and that It should be administered with utmost care. Therefore, this Commission cannot wholly rely on the statement of the expert witness produced by the Complainant. The testimony of the expert witness turned in favour of the Opposite Parties just to protect his professional colleagues from prosecution rather than finding out the truth."

At this outset, the Commission referred to the Supreme Court order in the case of V. Kishan Rao vs. Nikhil Super Specialty Hospital & Anr. to highlight that the Consumer Court can permit expert evidence but it is not bound by the view expressed by the expert because medical negligence is a mixed question of law and facts which is required to be resolved by the Forum.

The Commission observed that the patient was administered oxytocin for a period of 3 hours 50 minutes and this fact was admitted by a doctor during cross-examination. However, another doctor stated in his cross that oxytocin was administered for a period of 8 hours. Referring to these two statements, the Commission noted that this "...brings doubt upon the duty of care provided to the deceased as per the contradictory statements made by the said witnesses, Therefore, it was the case of not managing dosage of Injection Synto while it should have been administered carefully."

Further, the SCDRC referred to William Obstetrics to highlight that intravenous oxytocin should not be employed for more than a few hours, if, by then the cervix has not changed appreciably and if predictably easy vaginal delivery is not imminent, caesarean delivery should be performed. The medical literature also warns that oxytocin should not be used to force cervical dilation at a rate that exceeds the normal.

"We are of considered view that while the deceased patient was administered oxytocin, the concerned Gynecologist was expected to monitor her closely and carefully," opined the Commission. 

Referring to the doctor, who was the only full-time Gynecologist for the hospital and treated the patient since the beginning of her pregnancy, the Commission opined that the doctor was expected to monitor the deceased closely especially after having known her critical condition of having seizure and to provide due care.

The Commission referred to the statement of the doctor in the cross-examination submitting that he was not involved with the patient after she had seizure and the matter was handed over to another specialist in Anaesthetic.

On this, the Consumer Court noted,

"It is surprising to find that the Gynecologist was not involved in such a critical situation of the patient and was able to leave her when she was still in labour, under the care of only the Anesthetist. This clearly shows negligence towards the patient and that duty of care was not provided when it was very much understandable of the care and instant medical attention required by the deceased patient. Moreover, he had stated that there was no indication that the patient was not fit for caesarian. If so, we are also shocked to find that all possible remedies were not taken by the concerned doctor to save the life of the patient and her unborn baby even to the extent that emergency C-section could be performed if there was no indication that she was not fit for it."

Referring to the Supreme Court order in the case of Kusum Sharma & Ors. vs Batra Hospital and Medical Research Centre & Ors., the Commission reiterated, "...if a doctor does not adopt proper procedure in treating his patient and does not exhibit the reasonable skill, he can be held liable for medical negligence."

"It is also to be noted that the statement of the Opposite Parties No.1 made under oath and the notes of the doctors and nurses annexed at Annexure -1 by the OPs in their written statement are contradictory to each other. We are of the considered view that the aforesaid notes annexed was only an afterthought and that the statement made under oath is to be accepted," it further observed.

Referring to medical literature in the case of William's Obstetrics, the Consumer Court opined that administering Injection Synto (oxytocin) for about 8 hours did not aid the deceased in stimulating the labour. 

"The treating Gynaecologist examined her and artificial rupture of membrane was attempted, but failed due to high station of fetus. Employing Oxytocin for 8 hours is already long enough to determine whether easy vaginal delivery is not imminent. Apparently, the best option at that time was to employ caesarean delivery," opined the Consumer Court.

"In addition, we are of considered view that the delay or non-performance of C-section upon the deceased patient when the Gynecologist himself stated that there was no indication that she was unfit for the operation was an act of omission, thus negligence. Moreover, the non-involvement of the OP No.1, as per his statement, when the deceased patient was shifted to ICU but while she was still in labour is an act of omission and breach of duty of care owed to the deceased patient, thus negligence," it further noted.

Therefore, holding that there was negligence and the treating facility was liable to pay damages and compensation, the Consumer Court granted Rs 43 lakh compensation to the complainant.

"For award of compensation, we are of the considered view to allow a lump sum award of compensation of Rs.43,48,480/- (Rupees forty three lakhs forty eight thousand four hundred eighty only), which according to us is just and proper. Considering the loss suffered by the Complainants of losing their loved ones i.e. the wife and child for the Complainant No.1 and the mother and sister for the Complainant No.2, therefore, the Complainants deserve for justifiable compensation," it ordered. 

The Commission further said, ".. the New Life Hospital is no longer in operation and the New Life Polyclinic Society is running the Hospital or not is unknown to this Commission. However, the Doctors of the Opposite Parties No.1 (the Chairman of New Life Polyclinic Society and Gynaecologist) and Opposite Parties No.2 (Managing Director of Hospital and Anaesthetist) are practicing In the Ebenezer Medical Centre; the amount so awarded shall be deposited in the Mizoram State Consumer Disputes Redressal Commission, Aizawl within 90 days from the date of receipt of this order."

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/mizoram-consumr-court-234523.pdf

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