Pregnant Patient Death due to Hysterotomy: Delhi HC declines bail to Surgeon booked under IPC 304

The court's refusal was in credence to the findings of the Delhi Medical Council (DMC) that also stated the surgeon, neither being a qualified Obstetrician or Gynaecologist as required under the MTP Act and nor was there an urgency performed surgery for medical termination of pregnancy on a 19-20 weeks pregnant woman, who died during the surgery due to medical negligence.

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The case concerned a 31-year-old patient, who was admitted to R P Memorial Hospital here with 20 weeks pregnancy on July 8, 2015. She was diagnosed as a case of four months amenorrhea with placenta previa with bleeding and taken up for hysterotomy. She was referred to the Lady Hardinge Medical College and Hospital on July 9, 2015, where she breathed her last, reports Deccan Herald. The unborn child had also passed away. The post mortem stated death due to multiple organ failure consequent upon disseminated intravascular coagulation and hypovolemia (hemorhhage) which is possible in a known case of pregnancy who had complications during and after the termination of pregnancy (hysterotomy i.e. 1st operation)

A complaint was filed alleging medical negligence. Acting on a complaint, the DMC conducted disciplinary proceedings and found the doctor concerned, along with others, as guilty of medical negligence. The DMC had opined that the doctor, who is a postgraduate in the field of surgery, transgressed into the field of gynaecology by doing a procedure for which he is not trained and went beyond his knowledge, skill and competence. Noting the transgressions on the case, the DMC further noted

It is observed that as per the records available in this case, the patient went walking to the hospital with pain abdomen. Nowhere in the records, it is mentioned profuse bleeding was present on admission. USG dated 2nd July, 2015 of Mahindru Hospital had already detected placenta praevia type IV. No attempt was made to find whether it is adherent, in view of the fact that the patient also complained of pain. Intra-operatively placenta was found adherent. In such situation, one has to do hysterectomy rather than trying to remove placenta in piece meals. Piece meal removal of placenta results in torrential bleeding and if blood is not replaced well in time, the patient can have irreversible haemorrhagic shock, as it happened in the present case. The general surgeon is not well versed with obstetrical emergency procedures, hence, this patient should have been referred to a hospital set-up where gynaecologist was available alongwith the infrastructure to manage such a patient in the beginning only.

Further, the committee also noted the gross violations of the MTP Act, whereby for performing an MTP of 12-20 weeks, the opinion of two gynecologists are required which was missing in this case. 

The regulatory body confirmed the findings of the disciplinary proceedings, which recommended removing the name of the doctor from the list of registered practitioners for a period of 180 days. The order passed by the disciplinary committee was later also confirmed by Delhi Medical Council and the doctors name has been removed for 180 days

Meanwhile, the doctor who is facing charges under Section 315 (act done with intent to prevent child being born alive or to cause it to die after birth) and Section 304 (culpable homicide not amounting to murder) under the IPC submitted a bail plea with the Delhi High Court.

As per ANI, Advocate Madhusmita Bora, appearing for the doctor, told the court that the 70-year-old petitioner is a qualified medical surgeon and performed the surgery at the request of the hospital concerned. It was also submitted that the FIR is of the year 2015 but the petitioner was arrested on November 18 this year. Further he pointed that doctors should be booked under IPC 304A and not IPC 304

Public Prosecutor Neelam Sharma, on the other hand, vehemently opposed the bail application. She submitted that although, the FIR was registered under Section 315 (act done with intent to prevent a child being born alive or to cause it to die after birth) of the Indian Penal Code (IPC), subsequently, Section 304 IPC (culpable homicide not amounting to murder) was added as the patient had expired.

Sharma said the petitioner, admittedly, was neither on the panel of the hospital nor even a visiting surgeon and despite knowing fully well that he was not a qualified Obstetrician and Gynaecologist, still performed the surgery when there was no urgency as the pregnancy was only 19-20 weeks old. She also submitted that the charge sheet is yet to be filed and there is a strong possibility that the petitioner may tamper with the evidence.

She also apprised the court that a complaint was made to Delhi Medical Council, which, after disciplinary proceedings found all the doctors concerned guilty of negligence.

"In fact, it was found that co-accused, Hitender Vashisht, the in-charge/director of RP Memorial Hospital was not even registered with the DMC as he is not the holder of qualification in Modern Scientific System of Medicine and should refrain from pre-fixing 'Dr' to his name," she said.

A single-judge bench of Justice Manoj Kumar Ohri noted that the doctor has not denied the accusation that he had performed the alleged surgery on the deceased.

"Thus, keeping in mind the above-referred recommendations of the Disciplinary Committee, which stand confirmed by Delhi Medical Council (DMC), this court is of the prima facie view that there is a reasonable ground to believe that the petitioner has committed the offence," the bench said.

Noting that the investigation is still pending and the charge sheet is yet to be filed, the bench said that at this stage, it does not find any ground to admit the petitioner on bail.