Supreme Court slams NCDRC for creating new case on Antenatal negligence, orders Rs 10 lakh compensation REFUND to gynaecologist

However, the Apex Court bench held that the NCDRC's finding that there was no negligence in the delivery and post-delivery treatment had attained finality as the complainants did not prefer any separate appeal. Accordingly, it ordered the complainant to refund the Rs 10 lakh compensation received. 

The complainant lost his wife and his newborn son within the span of a few years. The Supreme Court was examining the validity of the finding that the obstetrician/Gynecologist who conducted the delivery was guilty of medical negligence and deficiency in service. While considering the matter, the State Consumer Court, Chandigarh, had found the doctor and the Nursing Home medical negligent on the ground that they did not exercise due care and caution in treating the patient, but there was no fault on their part insofar as the death of the newborn child was concerned. The SCDRC had directed the doctor and the nursing home to pay Rs 20,26,000 to the complainants.

When the order was challenged before the NCDRC, it concluded that the Nursing Home had no liability, and it pinned the entire responsibility of paying Rs 20,26,000 upon the treating doctor. As Rs 6 lakh had already been deposited, the top consumer court directed her to pay the balance sum of Rs 14,26,000 in 6 weeks along with costs. Despite the clean chit, the nursing home joined the treating doctor in filing the special leave petition before the Apex Court. By an order dated 10.02.2014, the top court bench directed a further sum of Rs 4 lakh to be paid to the complainants.

The Commission noted that the specific allegations levelled against the nursing home and the doctor were that the nursing home was not equipped to handle emergencies and complications during deliveries, the record of the treatment was fabricated later to escape prosecution, and the blood group of the patient was not checked, leading to delayed blood transfusions. It was also alleged that the death if the newborn baby was alos due to negligence, there was negligence in causing trauma to the patient by informing her of the death of the newborn, which resulted in shock and bleeding, and the nursing home had no stock of blood readily available for transfusion.

On the other hand, the nursing home and the doctor pointed out that the complainant had earlier reported the matter to the Senior Superintendent of police, Chandigarh, and consequently a Medical Board, consisting of experts, was formed to ascertain whether there was any medical negligence and the Board had negated the same.

They submitted that the patient suffered atonic postpartum haemorrhage which proved to be catastrophic as she did not respond to the treatment administered in the nursing home. It was stated that the PPH was a failure of the uterus to properly contract after the child is born resulting in bleeding within the uterus, which cannot be controlled.

It was asserted that proper treatment was given as per protocol, but despite the same, she did not respond and ultimately died. They alleged that the patient's family did not reveal about the complications in the delivery of the first child and that the first child was autistic. She asserted that had this fact come to her knowledge earlier, she might have refused to undertake the delivery, as there were more chances of the second child having congenital abnormalities if the first child had them.

The State Consumer court found fault with the treating doctor for not getting the patient's blood group identified at the time of delivery and in arranging for transfusion by keeping blood supply ready. It concluded that the nursing home and doctor wasted almost two hours in getting blood and cross-matching it and this led to deterioration of the patient’s condition. Further, it found fault with the doctor who managed the Nursing home for not accompanying the patient in the ambulance to the PGI. 

When the matter reached NCDRC, it took note of the opinions given by medical boards. Noting the doctor's claim that she was not informed about the details of the delivery of the first child, the NCDRC observed that it was the minimum professional requirement for her to have gathered such information. The NCDRC also found fault with the medical record maintained by the nursing home after the patient's first visit. It was noted that the doctor had claimed that the prior medical record was not given to her and it noted that the doctor had failed to ascertain information which had crucial implications, i.e., with regard to the patient's haematological status.

Referring to this, the Supreme Court bench observed, "We may observe, at this stage, that the NCDRC seems to have visualized itself in the role of a medical professional and expressed purported expert opinions on how Dr. *** ought to have acted as an Obstetrician when *** (patient) came to her initially and as to how she should have gone about prescribing tests!"

The Apex Court bench noted that NCDRC opined that though all the Medical Boards had opined that there did not appear to be any gross medical negligence in the management of the patient by the treating doctors after the delivery, the same did not mean that there was no medical negligence before the delivery.

As per the NCDRC, there were several instances of departure from standard protocols in the antenatal care of the patient on the part of the treating doctor, as she failed to insist on the patient getting standard haematological investigations done. According to the NCDRC, no case of tortious medical negligence was made out against the treating doctor in handling the patient's labour, including the delivery, the management of the baby, the baby’s problem and the post-delivery management at the nursing home, but there was enough evidence as well as expert opinion to hold that antenatal management of the patient by the doctor, particularly, in respect of necessary haematological and cardiological investigations, was not in accordance with the standard protocols that an Obstetrician of average skill would adopt. It further held that no case of medical negligence/ deficiency in service was made out against the nursing home, as there was nothing in the Medical Boards’ Reports on this aspect, and the complainants did not lead any reliable evidence in support of their allegations in this regard.

The Supreme Court bench observed that the Board of doctors from Government Hospital, Sector 16, Chandigarh, opined that the patient had died because of severe atonic PPH, which did not respond to the treatment given at the nursing home. It was recorded that the treatment given was as recommended and that blood was not arranged beforehand for normal deliveries.

A Board of doctors of Government Medical College and Hospital, Sector 32, Chandigarh, concluded that the patient had atonic PPH, which was managed conservatively but without success. It was noted that PPH is a known complication of delivery and accounts for 8% of maternal mortality in developed countries. The Board opined that different patients may cope differently with blood loss in PPH - a healthy woman would be far more tolerant to blood loss of 30- 50% when compared to a woman with either pre-existing anaemia or underlying cardiac complications or pre-eclampsia. The Board opined that it could not be said with certainty from the record whether this patient had anaemia or hypotension and shock before delivery, but in the presence of either or both of these conditions, atonic PPH was more likely to be catastrophic. This conclusion of the Board did not indict the doctor but left the question open as it was not clear from the record whether the patient had any of these conditions before the delivery.

Taking note of other reports, the top court bench noted that, except for one report, which, owing to a lack of sufficient data, left one question open, i.e., the possible pre-existing conditions that may have led to the death of the patient, none of the reports held the treating doctor negligent.

"Further, given the settled legal position that every failure in the treatment of a patient does not automatically lead to an assumption of medical negligence, we find that the opinions expressed by the doctors and experts, who constituted these Medical Boards/Committees, clearly tilted the balance in favour of Dr. ***, as none of them found any medical negligence on her part. As already noted hereinbefore, these bodies were constituted at the behest of *** (complainant) himself and he cannot, therefore, fight shy of the conclusions and findings rendered by them," observed the Supreme Court.

It further noted that NCDRC's ultimate conclusion was that there was negligence on the part of the treating doctor only in the antenatal care and management of the patient.

"More importantly, the NCDRC rendered a clear finding that there was no medical negligence in the handling of *** (patient) labour, including her delivery; the management of the baby’s problem; and the post-delivery management at the nursing home. These conclusions, arrived at by the NCDRC, not only reversed the findings of the SCDRC but also turned the very case put forth by the complainants on its head. In fact, the NCDRC decided the matter by building up a new case altogether!" the bench noted at this outset.

The court noted that the specific claim of the complainant was that there was medical negligence on the part of the treating doctor and nursing home in the post-delivery treatment only, as sufficient facilities were not available in the nursing home to deal with post-delivery emergencies and that the treating doctor failed to take adequate care and caution after the delivery to save the life of the patient. The complainant had categorically asserted that the nursing home was ‘inadequately and ill-equipped’ to handle emergencies during deliveries and there were no facilities available in that regard. His further allegation was that the patient was informed about the death of the newborn child, which resulted in her going into shock and caused profuse bleeding.

"However, this was not proved and neither the SCDRC nor the NCDRC recorded a finding on this aspect. His further allegation was that there was delay in arranging for blood transfusions and there was negligence during the transfer of *** from the nursing home to the PGI. He made no allegations whatsoever to the effect that the antenatal care and management of *** were deficient in any manner. On the contrary, he specifically asserted that various tests were prescribed by Dr. *** and *** underwent all such tests," the bench observed at this outset.

Criticising NCDRC for building a new case, the top court bench noted,

"The specific finding of the NCDRC was that Dr. *** had not prescribed the requisite haematological tests for ***. This was never the case of ***. The entire focus of the NCDRC, however, was only upon the antenatal care and management of the patient and its pinpointed findings were also in relation to the said period and treatment only. The NCDRC’s observation that there were several instances of departure from standard protocols in the antenatal management of the patient, such as, not getting proper tests done, and its final finding that no case of tortious medical negligence was made out against Dr. *** in handling labour, her delivery, management of the baby and his problem, and the post-delivery management of both of them at the nursing home, demonstrated and settled in no uncertain terms that the case put forth by *** was not proved and established. Once his case, as pleaded and projected, was not made out, the NCDRC clearly erred in building up a new case on his behalf and in pinning negligence and liability upon Dr. *** in the context of antenatal care and management of the patient, which was never the subject matter of the complaint case."

"In doing so, the NCDRC overstepped its power and jurisdiction as it was not for it to travel beyond the pleadings in the complaint case and build up a new case on its own," it held.

The Court referred to the judgment in the case of Ram Sarup Gupta (Dead) by LRs vs. Bishun Narain Inter College and others, where the Apex Court had observed that it is well settled that no party should be permitted to travel beyond its pleadings and that all necessary and material facts should be pleaded by a party in support of the case set up by it.

"Viewed thus, the NCDRC clearly transgressed its jurisdiction in building a new case for the complainants, contrary to their pleadings. However, its finding that there was no negligence in the delivery and the post-delivery treatment of *** have attained finality as no separate appeal was preferred by the complainants. The impugned order passed by the NCDRC, confirming the SCDRC’s judgment on the new grounds made out by it, therefore, cannot be sustained," held the Apex Court bench as it directed the complainant to refund Rs 10 lakh received as compensation.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/deep-nursing-home-vs-manmeet-singh-300454.pdf

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