Episiotomy done by Pharmacist: Delhi Hospital told to pay compensation for medical negligence

Subhash Chandra, Presiding Member of the Commission was looking into a revision petition filed by Shree Jeewan Hospital, New Rohtak Road that challenged the order issued by the State Consumer Disputes Redressal Commission, Delhi. The State Commission had dismissed the petitioner's appeal against the order of the District Consumer Disputes Redressal Forum (Central), Kashmere Gate, Delhi. The impugned order upheld the District Forum's decision, and punitive costs were imposed on the petitioner.

The Complaint: A Needle Left Inside the Patient's Body

The case originated from an incident on September 15, 2009, when the patient was admitted to the hospital for childbirth. However, during the childbirth process, while the doctors were stitching her up, they accidentally left a needle inside her uterus. This led to severe bleeding and caused her a lot of pain and emotional distress throughout the night.

The problem was not discovered until the evening of September 16, 2009, when an X-ray was taken. The X-ray showed that a needle had been left inside the woman's uterus. Consequently, a surgery was performed to remove the needle on the same day.

Later, on November 24, 2009, the woman underwent an ultrasound of her abdomen. The ultrasound revealed that her uterus had retroflexed, which means it had an abnormal backward tilt. Medical experts suggested that this condition might prevent her from conceiving in the future. The woman alleged that these complications were a result of negligence on the part of the hospital.

Legal Proceedings and Previous Decisions

Aggrieved, the woman filed a complaint against the hospital with the District Forum, seeking Rs 10,00,000 as compensation for her suffering. The District Forum conducted an investigation, and based on a report from the Delhi Medical Council, they found that the hospital was indeed at fault for medical negligence. The District Forum awarded the patient Rs 3,00,000 as compensation for the distress, pain, and mental agony she endured. They also ordered the hospital to pay Rs 10,000 for her legal costs.

Unsatisfied with this decision, the hospital appealed the case to the State Commission. However, the State Commission not only upheld the District Forum's decision but also added more charges against the hospital. They instructed the hospital to deposit a significant amount of money in the State Consumer Welfare Fund, totaling Rs 30,00,000.

The Present Revision Petition

Still dissatisfied with the decision, the Shree Jeewan Hospital filed a revision petition under the Consumer Protection Act, claiming that the punishments imposed on the hospital were too severe.

NCDRC carefully examined the arguments presented by both sides and the available evidence, and noted the findings of the District Forum and State Commission.

The District Forum, serving as the initial adjudicating authority in the case, reached several conclusions. It determined that the hospital's reliance on the Delhi Medical Council's opinion was unjustified, emphasizing the noted adverse effects of the needle left in the patient's body, including significant pain, mental distress, and increased bleeding. The Forum asserted that the suffering could have been avoided with greater care from the hospital's doctors. While the complainant's assertion that the needle caused her uterus to retroflex lacked substantial evidence, with a report from the Banwari Lal Charitable Imaging Center not conclusively linking it to the needle, the Forum acknowledged that other factors could contribute to the retroflexion. Additionally, the complainant's lack of expert opinion, beyond her own statement, was noted, though the Forum maintained that the complaint of medical negligence, causing suffering and mental agony, was valid, despite the absence of extra charges. Consequently, the complaint was upheld, accompanied by specific directions to the hospital.

On the other hand, in its decision, the State Commission raised significant additional concerns regarding the hospital's actions. Firstly, they questioned the hospital's choice of a pharmacist rather than a qualified doctor, particularly for a procedure that traditionally requires a skilled and well-compensated medical professional. The lack of clarity on how many similar procedures the pharmacist had conducted further raised doubts. The absence of clinical notes indicating the needle left during the stitching procedure, coupled with discrepancies in the authorship of medical records, added to the hospital's negligence. The failure to inform the patient about the needle left in her body, the absence of planned X-rays, and the delayed recommendation for an X-ray when the patient complained of severe pain reflected inadequate communication and responsiveness. The discovery of a complete needle in the patient's X-ray highlighted the hospital's gross negligence. Moreover, allegations of record manipulation to conceal the absence of a qualified doctor during delivery and the hospital's deficiency in service for having a non-operational X-ray machine when urgently needed further undermined the hospital's credibility and accountability.

Argument

It was noted by the Commission that the complainant/respondent's counsel referred to a Delhi High Court judgment from April 8, 2016, in a Public Interest Litigation (PIL) case (Delhi Medical Association Vs. Principal Secretary (Health) & Ors., in WP (C) No. 7865/2010). This judgment determined that a person practicing modern scientific medicine and its branches should be qualified to practice allopathic medicine under the Indian Medical Council Act, 1956, and the Indian Medical Degrees Act, 1916.

The argument was that the doctor, who performed the surgery, was a qualified pharmacist but not a medical practitioner. Therefore, the petitioner (the hospital) was negligent in allowing her to conduct the surgery and suturing, during which the needle was left in the patient's abdomen.

The counsel argued that, "Dr XYZ who performed the surgery was a qualified Pharmacist but not a Medical Practitioner and therefore the petitioner had been negligent in service qua the respondent in allowing her to perform the surgery and suturing following the episiotomy during the course of which the needle was left behind in the abdomen."

Findings and Facts

The main question in the case revolved around whether the act of leaving a needle inside the patient's abdomen can be considered medical negligence and if it caused the uterus to retroflex (bend backward). Another issue was whether the hospital followed the correct procedure by allowing a person who wasn't qualified to perform surgeries but was a pharmacist to conduct the operation.

The Commission noted;

"Based on the report of the Delhi Medical Council and the expert opinion of Lady Hardinge Medical College, New Delhi it is evident that the needle was inadvertently left in the superficial layer of the muscle during the course of stitching the episiotomy wound postdelivery. There was no ‘breakage’ of the needle per se as the x-ray revealed that it was intact and only the 0.2 vicryl thread had separated or ‘broken’, resulting in the needle slipping into the folds of the muscles. Both opinions are clear that the needle was not left behind in the uterus and that the fact of the needle being in the muscle cannot be the reason for the uterus to get reflexed. However, it is clear, based upon the statement of Dr Anitha to the Police that the surgery was performed not by one Dr Anita as per the petitioner but by Dr XYZ, a pharmacist who was present at the time of the delivery."

It further explained;

"In view of the fact that the needle was indeed left in the abdominal muscles of the respondent/complainant during the course of post delivery suturing of the episiotomy done by a person qualified not as a medical doctor but a pharmacist, medical negligence on part of the petitioner is established. This is also evident from the fact that the petitioner attempted to cover up the record through overwriting, as noted by the State Commission. Based on the reports of the Delhi Medical Council requisitioned by the DCP, as well as the Maulana Azad Medical College, New Delhi obtained by S I Pravesh Kaushik, it is manifest that the surgery was performed by an unqualified medical doctor (Dr XYZ). This itself is enough to establish medical negligence on part of the petitioner in the fact of the needle being left in the abdomen of the patient. It is also not disputed that the needle was left in the body of the respondent. There is nothing on the record to establish the fact of the leaving behind of the needle as the cause of the uterus reflex. The needle was also not located by the x-ray to be in the uterus. Therefore, the issue of the uterus getting reflexed due to the fact of the needle being left behind in the body needs to be answered in the negative. Hence, there can be no liability latched on the petitioner on this account."

The petitioner hospital argued that the State Commission's decision to impose punitive costs is unjustified as there was no request for it. They reference a Supreme Court case (General Motors (India) Pvt. Ltd. Vs. Ashok Ramnik Lat Tolat) that set aside punitive damages awarded by the National Commission because the relief was not sought in the complaint. Since the State Commission was considering an appeal against the District Forum's order, which did not include a plea for punitive costs, the State Commission's decision to impose such costs cannot stand legally, the Commission clarifed.

Final Verdict

Considering the above discussion and the case's circumstances, the petition partially succeeds. The Commission held;

"As stated above, the order of the State Commission in respect of punitive charges does not sustain since there was no pleading for the same. Accordingly, the same is disallowed and set aside. However, the order of the District Forum does not merit any interference in view of the establishment of medical negligence on the basis of the expert opinion and the establishment of the fact that the surgery was performed by a person who was only a pharmacist and not a qualified medical practitioner authorized to practice modern scientific system of medicine and all its branches. The order of, the District Forum is therefore affirmed subject to the setting aside of punitive charges awarded. Pending IAs, if any, stand disposed of with this order."

To view the original order, click on the link below: