Patient carried dead foetus for week before dying herself: Odisha HC slams govt, orders 10 lakh compensation, immediate action against doctors

Odisha: Coming down strongly on doctors, health workers as well as the government in the case of the death of a female patient who was apprently carrying a dead foetus in her body for 5 days and later passed away, the Odisha High court has issued a series of directions in a medical negligence case. 

The bench of Orissa High Court issued directions to the State Government to take strong action against the errant doctors, and provide compensation of Rs 10 lakhs to the family members of the deceased patient due to the negligent and careless attitude of the doctors and constitute schemes and policies for the pregnant women concerning the issue of maternal deaths.

The case concerned a deceased pregnant lady who apparently carried her dead fetus in her body for 5 days due to the lack of care and attention of the treating doctors and hospital.

It was alleged by the father-in-law in his plea that he had taken the deceased patient to Garabandha Primary Health Center (PHC), for her checkup as she was complaining of chest and abdominal pain during her pregnancy, and the same was noted in the OPD register. Due to the unavailability of the treating doctor, the deceased patient's father-in-law called the midwife who referred the patient to District Health Hospital (DHH), Paralekhamundi. The patient even on being 9 months pregnant and on not getting appropriate care returned with her father–in–law to her house and a week later (on 24th March 2015) she again complained about getting abdominal pain and that her child was not moving. The pregnant lady was taken to the District Health Hospital for an antenatal checkup, where, the doctor examined her and saw swelling on her face and legs. The doctor after the checkup informed the patient that there was no movement of the fetus and it could cause complications. However, she did not prescribe any medicine to the patient for the complications caused due to intra-uterine death, and neither she referred her to a specialist in Obstetrics and gynecology.

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On the night of 24th March 2015, the doctor specialist in obstetrics and gynecology came to the deceased patient's house for her checkup where she examined her ultrasound report which confirmed the dead fetus inside her uterus. "Intra Uterine Death (IUD) with severe Oligohydramnios".

The next day, on 25th March 2015, the patient was taken to the District Health Hospital, Paralekhmundi, where she was admitted into the labor room unattended due to which her condition kept on deteriorating as she gasped and her blood pressure was continuously dropping and finally she succumbed to death.

The father-in-law in his plea elicited the facts and alleged that the death of the patient (his daughter-in-law) and the baby (intra-uterine death) was due to medical negligence and was avoidable.

On the other hand opposing the plea of the aggrieved father-in-law, the treating hospital of the deceased patient claimed that there was no medical negligence on their behalf.It was also shown to the court, that the accused hospital had conducted an inquiry into the maternal death of a patient in question.

To get a clearer picture of the said allegations and defense from both parties respectively, and to make a note of actual factual circumstances, the bench requested the State Commission for Women, Odisha (SCWO) to assist them.

The findings of the Enquiry Committee made some observations-

"On an in-depth consideration of oral, documentary evidence and surrounding circumstances, the Enquiry Team is of considered view that the deceased Martha Sabar died due to combined negligence of doctors un duty of DHH, Paralakhemundi in the district of Gajapati and Garabandha PHC (New), ASHA, ANM and AWW. Adequate financial assistance to the victim for untimely death of deceased due to medical negligence is not the solution specifically when the husband of deceased is an irresponsible person and habitual drunkard having no care and affection towards old father and ailing mother. Efforts should be made by Highest Hon'ble Court to penalize erring doctors/DHH who have betrayed the faith of a tribal illiterate poor woman and to issue instructions to ensure timely availability of all schemes to poor persons in true sense of the action and not by paperwork."

"In the instant case, on the basis of statement of AWW, ANM, ASHA, PHC record and on the basis of medical record it is evident that the patient was not kept under care and standard protocol was not monitored.""

The Court made the observations based on the report of the Enquiry Committee which inter alia found the negligence on the part of doctors and staff members of the treating hospital at several levels and recorded,

"The findings of the EC in the above report have not been challenged by the counsel for the State. This Court, therefore, proceeds on the basis of the conclusion reached by the EC that the death of Martha Sabar was due to the collective negligence of the treating doctors both at the Garabandha PHC (New) and the DHH, Parlakhemundi. The extent of negligence is palpable in the finding: "In bed-head ticket, the cause of death is shown to be due to severe sepsis with pulmonary embolism but no oxygen was provided." This Court also notes that not only did the deceased not receive the benefits under the various schemes, but she even "spent money in the hospital for blood test and for Ultrasound test through Private Radiological Centre."

The court also highlighted the failure of the healthcare system in the rural areas due to which the poor tribal women are falling prey to the inefficiency and negligence of the doctors.

"The victim was a poor tribal woman whom the State health care system failed. Despite so many schemes on paper, meant to deliver benefits to her, she died due to the sheer callousness of the State authorities, doctors, para-medical workers and staff. Even the basic first-level care and treatment at the level of the ASHA and ANM under the NHM were not provided to the deceased in the present case. She was never given advice although hers was a high-risk pregnancy. She was carrying a dead foetus for a week and received no treatment. This was despite the revised guidelines, drawn up separately for the sub-centers, the CHCs and DHHs, being operational since 2012. It is indeed extremely unfortunate that the benefit of the multifarious schemes which are meant to cater to the needs of the poor and vulnerable like the deceased in the present case do not reach them in time."

After making the note of the following observations from the report filed on record by The Enquiry Committee of the State Commission for Women, Odisha,

The bench also made a reference to the previous judgments to direct the state to provide pregnant women with the necessary schemes and policies to avoid maternal deaths.

"In the present case, there has been an acute failure of the entire teams of doctors at each level of the health care system in Odisha to provide timely and adequate care and treatment to the deceased as pointed out by the EC. It shocks the judicial conscience that a poor tribal woman had been carrying a dead foetus for a week prior to her death with not one person in the health care system being able to provide her the needed care and treatment and which neglect resulted in her inevitable death. There has been a clear violation of the fundamental right to health of the deceased which constitutes an integral part of the right to life guaranteed in Article 21 of the Constitution of India."

Therefore, after considering all the aspects of the presented case of the death of a patient and her baby due to intra-uterine death, due to the alleged medical negligence on the part of the doctors, the court issued the following directions -

Also Read:Odisha: Minor boy dies at District hospital, family alleges medical negligence

Directions for the payment of compensation-

The court issued a direction of payment of Rs 10 lakhs of compensation within six weeks from the date of judgment to the family members (the father-in-law, mother-in-law, and her husband) of the deceased patient by the virtue of fixed deposits as directed.

"This Court, therefore, has no hesitation in directing that for the avoidable death of the deceased, the Government of Odisha should pay the family members the sum of Rs.10 lakhs within a period of six weeks from today. The compensation amount will be kept in fixed deposits (FDs) as directed hereafter. FDs for Rs.3,50,000/- each will be made in favour of the mother-in-law and the father-in-law of the deceased Martha Sabar and an FD for Rs.3,00,000/- in favour of her husband Ganpati Sabar. The FDs will be initially for a period of one year each and will not be permitted to be encashed during that period. The interest therefrom will be credited on a quarterly basis to the respective savings bank accounts of the aforementioned three persons."

Actions against the errant doctors, healthcare workers, and staff-

The court based on the findings of the Enquiry Committee issued directions to the State government to issue the show cause notices to the doctors for their negligent behavior as per the Enquiry Committee of the State Commission for Women, Odisha in its report and take disciplinary action against them after receiving their replies within six months.

"The State Government will immediately issue show cause notices (SCNs) to each of the doctors, health workers and staff whose conduct has been adversely commented upon by the EC of the OSCW in its report;" "After receiving their replies to the notices, and following the due process of law, if so warranted, disciplinary action will be taken against each of the said persons in accordance with law. The Court clarifies that nothing stated in this order or the report of the EC will be construed as the final opinion as regards the individual conduct of such persons." "The State Government will file a compliance affidavit as regards the above directions along with the reports of the inquiry and/or the action taken thereon within a period of seven months from today. If there is a failure by the State Government to do so, the Registry will list the matter before the Court for directions."

Directions to a Comprehensive Action Plan and Policy-

The court stated that the increasing number of maternal deaths in Odisha points to the deficiency and failure of the healthcare system, there is an urgent need for proper orientation, training, and sensitization of support workers including ASHAs, ANMs, and Anganwadi Workers who play a crucial role in delivering the healthcare services.

The court also issued directions to the State Government through its Additional Chief Secretary (Health) Government of Odisha, on the suggestions made by the State Commission for Women Odisha to constitute an advisory body of healthcare experts to draw up a comprehensive action plan which will contain both preventive and remedial measures to address the issue of maternal deaths.

"The State Government must separately come up with a Scheme or Policy to address the need for providing redress including award of compensation for every needless maternal death, the fixing of responsibility on errant doctors, para medics and staff in a time-bound manner, which will obviate the need for every individual case to be taken to either the OSCW or the Odisha Human Rights Commission (OHRC) or even this Court for remedial measures." "The exercise of drawing up a Comprehensive Action Plan and formulating a Scheme/Policy for providing compensation as directed above be completed within a period of four months from today."

To read the full judgment, click below:

https://medicaldialogues.in/pdf_upload/displayphp-189972.pdf