Delay in Shifting patient is Medical Negligence: HC holds Govt facility guilty, directs Rs 5 lakh compensation to patient who underwent Forceps Delivery

Chennai: Slamming a Mettupalayam based Government Hospital for faliing to shift a patient to Coimbatore Medical College Hospital, the Madras High Court recently awarded Rs 5 lakhs compensation to a young mother who had to undergo three surgeries at a private facility after the hospital delayed discharging her to the better facility.

Although the petitioner had developed perineal tear after her forceps delivery, the Government facility did not shift her to Coimbatore immediately even though it could not provide adequate care to the patient. 

Holding the hospital guilty, the bench comprising of Justice Mr. N Anand Venkatesh noted, "The 3 rd respondent hospital, after having realised that the petitioner cannot be given adequate care in the hospital, should have immediately shifted the petitioner to the Coimbatore Medical College Hospital...In fine, this Court holds that there was a clear negligence on the part of the 3 rd respondent hospital for not having taken proper care of the petitioner and for having failed to shift the petitioner to Coimbatore Medical College Hospital when the situation really warranted."

Back in 2005, the petitioner had been admitted to Mettupalayam Government Hospital for the delivery of her child. The Medical Officer of the Hospital, Dr. Tamilselvi had conducted the delivery and due to a last minute complication, the doctor had to use forceps and it required stitches.

It was alleged that from the next day of the delivery, puss was oozing from the surgical scars and the petitioner was experiencing difficulty in urinating and defecating. A few days later, the doctor removed the stiches and redid it once more. Despite this, the situation did not improve and puss continued to ooze out of the scars and in fact it was dribbling down the legs. The patient was experiencing extreme pain and hardship. 

Since the patient's condition did not improve, the husband of the petitioner decided to discharge her from the hospital. However, the Medical Officer of the Hospital, Dr. Tamilselvi asked the petitioner to wait for a second surgery that would be performed by Dr. Ilanchezian, who was not readily available at that time. However, the petitioner's husband insisted for the discharge and following this, he took the petitioner to a private hospital immediately.

The private hospital allegedly informed the petitioner that her rectum had been badly injured. The reason for this was mentioned as forceps delivery and the fact that it had not been stitched and treated properly, resulting in infection. Therefore, the doctor at the private hospital informed the petitioner about the need for a three stage surgery required to address the problem.

Consequently, the first surgery was conducted within a few days of the delivery. Following this, the left leg of the petitioner began to swell and therefore, the patient had to be admitted in the vascular care centre for nearly 15 days. After the swelling subsided, the second surgery had been conducted in May 2006 and the third one in July 2006.

For these three surgeries, the petitioner allegedly had to pay Rs 1.5 lakh towards surgery expenses only, excluding the money required for medicine, rent and travel expenses. Apart from this, the petitioner suffered heavily since she could not take care of her new born child for nearly nine months. 

Citing these reasons, the petitioner approached the Madras High Court and sought Rs 10 lakh as compensation and sought direction upon the Director of Medical and Rural Health Services to initiate appropriate disciplinary action against the doctor, who was allegedly negligent while performing the operation. However, the court noted that the second prayer was invalid since the doctor had died during the pendency of the plea.

On the other hand, the Director of Medical and Rural Health Services submitted that shifting to the private hospital had been the decision of the petitioner and her husband. Even though they had been advised to wait for a second surgery, they insisted for discharge.

Apart from this, the Director had also referred to the Inquiry report by the Joint Director of Health Services, Coimbatore at Tiruppur. The concerned report had mentioned, "In my opinion there is a possibility of occurrence of complete perineal tear in the patient Mrs.Banupriya which can be treated and managed at Coimbatore Medical College Hospital, Coimbatore where there were enough facilities available. Under the above enough circumstances and on the basis of the opinion statement submitted the by the expert doctors I am to conclude that No negligence is noticed on the part of Doctors who gave treatment to the patient and hence the question of rendering financial remedy to the petitioner does not arise."

The hospital and the doctor had also denied negligence on their part. It had been submitted by the hospital that the petitioner was alright for the first four days and after that she started having problems and it was found that there was a breakdown of muscle and skin layer which is a common complication for any surgical procedure depending upon the health. Following this, the patient had been put on higher antibiotics and the doctor had re-sutured the wound. 

"Such repaired wound sometimes breaks down more than once, inspite of efficient and meticulous efforts requiring repeated repairs because of poor resistance power of the patient and proximity of the wound to anus which leads to all infections with known and unknown bacteria, some of which are resistant to all available antibiotics," submitted the hospital.

It was further claimed by the hospital that the petitioner's husband had allegedly insisted for the discharge of the patient even though the hospital had suggested referring the patient to Coimbatore. 

After considering the submissions made by both the parties, the High Court bench noted that the Apex court has repeatedly held that a medical practitioner cannot be held to be negligent just because something went wrong while performing the procedure or surgery, inspite of the best efforts put in by the doctor and the doctor had exercised a reasonable degree of care, skill and knowledge as is expected under normal medical standards.

The HC bench noted that the doctor had performed episiotomy, a regular procedure adopted for normal vaginal deliveries. In this procedure, an incision is made on the vagina of the patient to make space at the outlet bigger for the baby to come out comfortably and to make the birth easier and in order to avert a possible brain damage for the baby.

Referring to the relevant medical literature, the bench observed that it is common for the perineum to tear to some extent during childbirth. In fact, tears can also occur inside the vagina or other parts of the vulva, including the labia.

Opining that the decision of forceps delivery was right on the part of the doctor, the bench noted, "It is clear from the above that the 4 th respondent was forced to adopt this procedure since the baby's head was at the outlet and was not able to come out and the petitioner was not able to strain any further. That apart, the fetal heart rate was decreasing and in order to save the baby, the 4 th respondent applied outlet forceps after giving episiotomy, whereby, the perineum was cut down to create space for the delivery of baby. This procedure adopted by the 4 th respondent cannot be held to be negligent and she had taken the decision in the interest of the petitioner and her baby."

In fact, the court held that the doctor could not be blamed for the perineal tear as well. The court noted, "On going through the medical literature, it is seen that a perineal tear is not uncommon after an episiotomy procedure. In fact, there is a possibility of 4 degrees of perineal tear."

Referring to several degrees of the perineal tear, the bench noted, "It is clear from the above that complete perineal tear that resulted from the procedure, cannot be held to be negligence on the part of the 4 th respondent doctor."

Therefore, exonerating the doctor from charges of medical negligence, the bench noted, "...this Court does not have the expertise to hold that the procedure performed on the petitioner by the 4 th respondent resulting in the complete perineal tear was as a result of insufficient care taken by the 4 th respondent."

However, while considering the negligence on the part of the hospital, the bench noted that even though the hospital claimed that the advise for shifting to Coimbatore had been turned down by the petitioner's husband, nothing of this sort had been mentioned in the discharge summary. The court observed, "Even in the discharge summary, there is absolutely no reference to the effect that the petitioner was referred to the Coimbatore Medical College Hospital. It only states that the patient was discharged at request."

At this outset, the bench further noted,

"This situation could have been averted by the 3 rd respondent hospital by immediately shifting the petitioner to the Coimbatore Medical College Hospital atleast on 13.11.2005 and all these procedures could have been done in that hospital. The delay on the part of the 3 rd respondent which caused anxiety to the husband of the petitioner, should necessarily be held to be negligence on the part of the 3 rd respondent hospital. The 3 rd respondent hospital, after having realised that the petitioner cannot be given adequate care in the hospital, should have immediately shifted the petitioner to the Coimbatore Medical College Hospital."

"If this was not done and the 3 rd respondent was waiting for the arrival of a doctor who had gone on leave, the petitioner cannot continue to face pain and agony and under the given circumstances, the husband of the petitioner thought it fit to shift the petitioner to a private hospital. In fine, this Court holds that there was a clear negligence on the part of the 3 rd respondent hospital for not having taken proper care of the petitioner and for having failed to shift the petitioner to Coimbatore Medical College Hospital when the situation really warranted," it also observed.

Therefore, holding the Government hospital vicariously liable for negligence, the court awarded the petitioner with Rs 5 lakhs compensation and noted,

"The petitioner was admitted four times in the hospital to undergo three surgeries and to recover for her swelling of leg, in a vascular care centre. In this process, the petitioner was forced to spend towards surgery expenses, medicine expenses, travel expenses and also rental expenses, when they were forced to stay at Sathyamangalam, till all the three surgeries were completed. That apart, the petitioner also faced untold hardship in not being able to take care of her new born baby effectively for nine months. In view of the same, this Court is inclined to fix a lumpsum compensation of Rs. 5 Lakhs payable to the petitioner."

To view the order, click on the link below.

https://medicaldialogues.in/pdf_upload/govt-hospital-negligence-182572.pdf

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