Emergency Circumstances: NCDRC exonerates Surgeon, Hospital from negligence for conducting C-Section without Anesthetist

New Delhi: The National Consumer Disputes Redressal Commission (NCDRC) recently exonerated an Allahabad-based hospital and its surgeon from charges of medical negligence while performing Lower Segment Caesarian Section (LSCS) operation on a patient for the delivery of her child.

It was alleged by the husband of the patient that the doctor and the hospital were negligent since they conducted the operation without the presence of any Anesthetist.

However, dismissing the complaint, the top consumer court held that "...it was an emergency and the Opposite Party No. 2, though he was a Surgeon, performed LSCS under local anesthesia to save the mother and baby, which does not amount to medical negligence."

The matter goes back to 2014 when the complainant's wife had approached Dr R.K Agrawal for the delivery of her child. She had got admitted to Maa Sharda Hospital. It was alleged that Dr Agrawal, the Director of the Hospital himself administered anesthesia to the patient and performed the caesarian delivery. A male baby was born and consequently, the patient went into deep coma. 

It was alleged in the complaint that the patient had gone into coma due to wrong anesthesia and surgery. The same was allegedly informed to the husband of the patient at the time of shifting from OT to private room.

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Thereafter, the patient had been given electric shock in order to bring her memory back, but to no avail. Later, the patient was allegedly discharged from the hospital forcibly under the garb of referral to higher centres.

As per the complaint, the treating doctor suggested three hospitals in Lucknow. However, the patient was admitted to a hospital in Allahabad. Since there was no improvement of the comatose condition of the patient, she was discharged and the husband of the patient had to hire a permanent attendant for her care. 

Thereafter, the husband of the patient, the complainant registered an FIR and filed a complaint before the NCDRC bench. Alleging gross medical negligence on the part of the treating doctor and the hospital, he claimed Rs 2 crore as compensation.

On the other hand, the doctor and the hospital denied any negligence on their part. It was submitted that since the Anesthetist was not available, the doctor was not inclined to perform the operation, but he conducted the operation on the request of the husband of the patient and considering the emergency.

The doctor further submitted that during the operation, the patient was suffering from Pre-Eclampsia Toemia (PET). He also stated that after the completion of the operation and while putting stitches and dressing, the patient started convulsions on the operation table itself and Injection Epsilon was given immediately and afterwards the patient was shifted to ward.

Due to the serious condition of the patient, he had advised to shift her to higher centre, the doctor informed the top consumer court and denied any negligence on his part.

After considering the arguments made by both the sides, the bench also perused the entire medical record. The consumer court bench also noted that on the basis of the complaint by the husband of the patient, the Chief Medical Officer of Allahabad had set up a committee of three experts.

The report of the Committee dated 17.08.2015 clearly observed that “Dr. R.K. Agrawal, Director of Maa Sharda Hospital performed caesarian operation himself without assistance and advice of any other expert doctor like Anesthetist, Physician and Obst. and Gynecologist prior, during and after Operation and Dr. R.K. Agrawal (who is not Anesthetist) administered anesthesia. Due to medicines provided during caesarian section, hypotension leading to Cerebral Hypoxia was caused and in default of immediate treatment of same, the patient went under coma who is continuously in the same condition till now. Accordingly, Dr. Agrawal neglected in performing the operation without Anesthetist.”

However, the Allahabad Medical Association protested against the opinion of the Board and they made a representation to the District Magistrate for re-examining the case. Objecting to the report, the association had claimed that the President of the previous Medical Board, Dr. Kushwaha had acted very irresponsibly, and gave wrong opinion.

Therefore, another Medical Board was constituted with the direction of District Magistrate under the Chairmanship of Dr. R. K. Agrawal, Surgeon of Community Health Center Soraon, Allahabad consisting three Members. The Board thoroughly examined the matter and all the members of the Medical Board unanimously concluded that the patient was affected by PET followed by Eclampsia & Full Term Pregnancy. The patient further suffered few complications. However, despite proper treatment, the patient may go into coma. Thus, the previous Board failed to consider preeclampsia and its effects in the instant case as a cause of coma.

After perusing the entire medical record, the top consumer court opined that the doctor had conducted the Lower Segment Caesarian Section (LSCS) under local anesthesia for saving the mother and the baby.

"Based on foregoing discussion, in our considered view, it was an emergency and the Opposite Party No. 2, though he was a Surgeon, performed LSCS under local anesthesia to save the mother and baby, which does not amount to medical negligence. The reference letter on record also mentioned about the details of the treatment and he gave three reference letters for Neurology opinion from SGPGI Lucknow, K.G.M.C. Lucknow and Sahara Hospital. The opinion dated 17.08.2015 headed by Dr. J. L. M. Kushwaha failed to consider the issue of PET of pregnancy, which the patient suffered, was the cause of hypoxic event and coma," the NCDRC bench noted.

Therefore, exonerating the surgeon, the bench noted,

"The Opposite Party No. 1 acted as per reasonable standard of practice during the emergency situation. We do not find any negligence while conducting the operation, which was done to save the life of the baby. The patient was referred to proper higher centre at appropriate time, but the patient was taken to Preeti Nursing home for further management. We do not consider any fault of the patient at this stage."

At this outset, the bench also referred to the Supreme Court order in the case of Jacob Mathew vs. State of Punjab & Anr. where the top court bench had clarified that

"At times, the professional is confronted with making a choice between the devil and the deep sea and he has to choose the lesser evil. The medical professional is often called upon to adopt a procedure which involves higher element of risk, but which he honestly believes as providing greater chances of success for the patient rather than a procedure involving lesser risk but higher chances of failure."

To read the order, click on the link below:

https://medicaldialogues.in/pdf_upload/no-medical-negligence-ncdrc-200213.pdf

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