Septicemia after delivery not doctor's fault, rules Consumer court

The history of the case goes back to 2011, when the patient got herself examined by the treating doctor for her pregnancy and delivery. The patient came to the hospital of doctor with labour pain and delivered child i.e. the Complainant in the case, at 9:00 P.M. on 23/04/2011.

Based on the patient's request and after verifying all the parameters were normal, the deceased was discharged on April 26 and on May 2nd, the deceased came to the hospital with a complaint of pain in the abdomen. She was examined and advised Sonography and X-ray, to which the deceased refused, and hence was advised to go to the PDMC Hospital for treatment free of cost. The deceased died on the same day in the evening at PDMC Hospital.

The maternal uncle of the complainant filed the police complaint against the treating doctor, and consequently, the police made the inquiry and seized the documents of treatment given in the hospital of the treating doctor, as well as in the PDMC & Hospital. The Medical Board, headed the Civil Surgeon gave its report to the Police Station Gadge Nagar, giving an opinion about the cause of death of the deceased, as "Rupture of Urinary Bladder due to Massage etc."

When the matter came to be considered before the District Consumer Court, the treating doctor denied responsibility for the injury or rupture of the urinary bladder of the patient and submitted that it must have ruptured 24 hours before her death. She claimed the complaint to be false, mala fide and vexatious and urged the consumer court to dismiss the same.

Filing a rejoinder, the counsel appearing for the complainant submitted that one of the major symptoms of this deadly disease in case of female given birth to a child is foul-smelling vaginal discharge and pain in the vagina. It was also contended that even at the time of her discharge, the patient was having severe pain in the vagina and despite pointing it out to the doctor, the latter did not care for the same. Had the doctor not neglected the deceased and had taken proper care of her, the patient would not have been infected with Septicemia, argued the counsel.

Allowing the complaint, the District Consumer Court directed the doctor to pay Rs 5 lakh compensation with interest @9% p.a. from the date of the order. Aggrieved by the order, the doctor approached the State Consumer Court.

The State Commission noted that, based on the police complaint, the police referred the matter to a Medical Board at the General Hospital Amravati, seeking its opinion about the probable cause of the patient's death.

Consequently, the Medical Board, comprising the Civil Surgeon and other expert Gynaecologists of the General Hospital, verified all necessary and relevant facts and documents, including the record of the treating doctor's hospital, the record of the Dr Panjabrao Deshmukh Medical College & Hospital, Amravati and the postmortem report. The Medical Board also called the treating doctor for inquiry and questioned her. After due inquiry, the Medical Board gave its report to the Police Station, Gadge Nagar, on 07.07.2011. 

In the report, the Medical Board, gave a specific finding stating that there was no negligence on the part of the treating doctor in the patient's death.

"The copy of the report of Medical Board is filed on record, which is self explanatory. That it appears that after the patient was discharged from the hospital of the opponent, as per the practice prevalent in India, massage to the abdomen must have been given to the patient at her home and there is a possibility that the massage might have been given with full urinary bladder resulting into injury to or rupture of the urinary bladder. The opponent was not at all negligent and she was not responsible for the injury or rupture of the urinary bladder of the patient due to massage," observed the Commission.

"It is observed that as per the report of the Medical Board, the urinary bladder of the patient must have ruptured 24 hours prior to her death. That at the time of postmortem, the urinary bladder was found empty with perforation and all urine was found in the peritoneal cavity i.e. the abdomen and the quantity of the urine i.e. clear and yellowish, fluid in the peritoneal cavity was about two liters only which must have been produced within a day in as much as the deceased was given two saline bottles i.e. 1 Litre of fluid in the hospital of opponent on 02/05/2011 and was again given such fluid in PDMC Hospital and till the earlier day i.e. till evening of 01/05/2011, the deceased was taking her food with water and fluid," it further observed.

"We find much force in the contention of the opponent that if there would have been perforation to the urinary bladder either during normal pregnancy i.e. 23/04/2011 or up to 26/04/2011 when the deceased was discharged from the hospital of opponent, then the quantity of the urine or fluid in the peritoneum would have been much more than only two litres in as much as the deceased was taking her meals and consequently also water and fluids at least till 01/05/2011," the consumer court noted.

The State Commission mentioned that the probable cause of death of the deceased, as per the postmortem report, was due to septicaemia, which was caused due to rupture or perforation of the bladder and therefore, the deceased developed septicaemia after there was rupture or perforation of the bladder.

At this outset, the State Commission observed,

"The learned District Forum erred in not taking into consideration the subsequent addition of the word "old" in the column for giving opinion as to the probable cause of the death in the postmortem report, even though by the naked eye it is clear that while the other contents of the said column or the entire contents of the postmortem report are in a different handwriting, the word "old" is in different handwriting which shows that the relatives of the complainant must have got added the said word "old" in the postmortem report, after the postmortem report was prepared or it was submitted to the police."

It further observed that Sepsis after delivery may arise due to many factors viz poor hygiene, infection from outside the hospital, lack of post-natal care, patient's own condition (anemia, diabetes, etc.).

"The complainant must prove that the sepsis was a direct result of doctor's negligence (e.g., use of unsterile instruments, failure to give antibiotics when clearly indicated, failure to attend promptly when symptoms appeared)," the Commission noted.

Accordingly, after reviewing the evidence, the report of the Medical Board, the medical record of both hospitals, and the post-mortem findings, the Commission held that the death of the patient in this case could not be attributed to the treating doctor. With this observation, the Commission set aside the District Commission's order and dismissed the complaint.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/maharashtra-state-consumer-court-303061.pdf

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