Death due to Post-partum haemorrhage : Delhi Govt Hospital told to pay Rs 25 lakh to patient
New Delhi: Finding a government hospital guilty of medical negligence and holding that the Obst. & Gynae services should not be started or continued, if ancillary support services are not available which are vital for critical case, a Delhi consumer forum has directed Acharya Bhikshu Government Hospital to pay Rs 25 lakh compensation to the family of a patient.
This came following a complaint moved the death of a patient who succumbed to post-partum haemorrhage.
The case relates to a 36-year-old patient was under the supervision of doctors at the Acharya Hospital for pregnancy since May 2011. On November 18 2011, she was first admitted in the hospital with complaints of high BP, then discharged and then again re-admitted after few days in the hospital for a delivery However, until the next day afternoon, no information about her conditions was given.
She soon gave birth to a baby girl
The very next day, the complainant- the patient's husband was asked by the hospital staff to get a unit of blood from DDUH ( Deen Dayal Updhayaya hopsital). However, the complainant alleged that before leaving for DDUH, he was hurriedly asked to sign some blank papers, asserting the formality to be a routine matter. Soon after reaching the DDUH, he got a call from the hospital staff asking him to arrange 04 units of additional blood as the patient was bleeding profusely as the uterus was not retracting.
Accordingly, he reached the Acharya hospital where he was informed about the deteriorating condition of the patient.
Thereafter, the complainant was informed that the uterus of the patient needed to be removed immediately for which she had to be taken to DDUH as Acharya Hospital did not have ICU facility to operate upon the patients. As per the doctors, phone calls made to DDUH in order to inform about the patient's immediate reference went unanswered. Somehow, the patient was rushed to DDUH after waiting for 1.5 hours for the ambulance. Meanwhile, the patient was bleeding continuously as the uterus was not retracting.
It is alleged that the complainant was informed that her uterus needed to be removed immediately for which she had to be taken to DDUH as the hospital did not have ICU facility to operate upon the patients. The complainant added that there was severe delay in arranging ambulance and discharging the patient
On reaching DDUH, the doctors present there refused to attend the patient and argued about not informing them before bringing in the patient. The patient was anyway admitted in the ICU at DDUH. It is alleged that complainant’s wife was bleeding continuously during this entire period and no effort was made to stop the bleeding. Even artificial breathing was administered manually.
In the meantime, the complainant was trying to locate a private hospital when a doctor from Acharya Hospital informed that the patient has suffered a cardiac arrest and there was no point in shifting anywhere else. The doctors of DDUH shifted her to casualty ward and tried to revive her by pacing for half an hour, however, she passed away.
Pursuant to this, the complainant alleged medical negligence and severe delay and deficiency of services that subsequently led to the death of the patient. The complaint stated that at around 10.30 pm, the doctors of the government hospital brought the deceased back to the hospital and at about 11.00 PM handed over a slip to complainant in which the time of death was written as 9.30 pm on 19.11.2011 and handed over the dead body of the patient after making him sign some blank papers again.
No cause of death has been mentioned on the medical papers, he further alleged
It is was further brought to the forum's attention, prior to approaching the commission, the complainant had made a complaint to SHO Moti Nagar for registration of FIR and had also lodged a written complaint with Delhi Medical Council (DMC) against the accused persons in December 2011, wherein, the council via an order dated 26.08.2013 specifically observed that the hospitals were grossly negligent in handling the patient and was not even equipped with the most essential and mandatory requirements of carrying out a surgery in which case they should have never admitted the patient.
Subsequently, the complainant sought Rs 90 lacs towards compensation for loss of life, Rs 7,00,000 towards compensation for causing harassment and mental trauma and Rs 2,00,000 for other expenses including litigation expenses.
On the other hand, the hospitals filed a joined statement denying medical negligence on their part and asked to dismiss the complaint, stating that it is barred by limitation. It was also contended that the patient, after delivering a female child expired because of post-partum haemorrhage (PPH).
The hospitals stated in its response- "The bleeding uterine cavity of the patient was already explored and packed at the Acharya Hospital by the specialist before transferring the patient. The patient was already being administered artificial breathing in the hospital and blood transfusion was also on with oxygen and pulse oxi-meter and one senior resident doctor from Obst. & Gynae Department, one junior resident from casualty and one junior resident from Obst. & Gynae department along with OT technician was keeping a watch on the condition and vitals of the patient in the ambulance."
"The patient was managed for the same as per the protocol and when it could not be controlled by standard protocol she was shifted to higher centre DDU Hospital due to non-availability of ICU facility and also non-availability of adequate amount of blood to be transfused with proper resuscitative measures, " the hospitals added.
After going through the contentions; the New Delhi State Consumer forum noted that the hospitals failed to establish what exactly the line of treatment was rendered to the critical patient and if followed the standard medical practice in rendering this treatment. There was no documentary evidence on record to state or prove what line of treatment was adopted by the hospital arrest PPH, the commission added.
The court observed;
"In the present, nowhere, in the written statement, the OPs have stated, what are the steps were taken to prevent or arrest the Post Partum Hemorrhage and how they failed, thereby, compelling to take a decision to shift the patient. In the written statement, though the OPs had stated that the patient was managed as per the standard protocol. However, OPs have failed to state what standard protocol was followed; it appears to have been written leisurely, probably to cover up the mistake. In these circumstances, the conduct of the OPs should be construed as medical negligence, especially considering the fact, the patient was sent to DDU Hospital in a precarious condition."
The court further pointed out that the hospital was not having the correct numbers of the DDU Hospital, which also amounts to deficiency in service.
Significantly, the forum upheld the order passed by the Delhi Medical Council that made adverse observations against the hospital,
- The patient was booked with the said hospital, admitted with diagnosis of PET. She died after thirty hours of admission. The PPH can occur in any obstetric case. This is first serious cause of maternal death in our country. Any maternity unit of a respectable hospital should have facilities of anaesthesia, enough blood facilities and totally equipped blood bank and immediate protocol for transfer.
A per meeting of 24 December 2011 and after this mishap, the said hospital has admitted that:
- Ventilator was out of order for last six months.
- The blood units kept in hospital were markedly less in view of the total load of the hospital.
- Blood substitutes were not available.
- Definite policy for referral to higher centre was not in place which cause undue delay in this case.
- Ambulance was not available for immediate shifting.
- Since the patient was critically ill, the medical team thought that instead of risking a death in operation theatre, it was better to transfer the case to a nearby better equipped hospital in time.
- Record keeping was found to be poor. There was duplicacy/overwriting of serial numbers and monthly numbers at multiple places in the record keeping register of OBG emergency operation theatre.
- The validity of Blood Bank license had expired on 18.02.2009. At the time of the incident, the license of blood bank was not renewed due to shortcoming observed by drug control department for which blood storage centre was asked to carry out the improvements as suggestive vide letter No.F.No.05/BSC/mfg/DC/13238 dated 18 January 2010. However, th the hospital asked for renewal of license only on 27 February 2013.
- The patient was managed as per standard protocol, however, the Obst. & Gynae services should not be started or continued, if ancillary support services are not available which are vital for critical case. It was further noted that inspite of OBG and anaesthesia specialist available, surgery could not be done as blood or other life saving facilities were lacking
After a detailed deliberation the entire matter, the presiding member, Salma Noor held;
"In this case, admittedly, except compelling the complainant, to take the patient to DDU Hospital nothing had been done by the OPs, either in anticipation or after knowing the continuous bleeding that led to the death of complainant’s wife who left behind two minor daughters. For the above reasons, I conclude, that by the act of the OPs, there is medical negligence as well as the deficiency in service on the part of the OPs, for which, they are answerable."
The commission, finally directed he Acharya Bhikshu Government Hospital to pay the compensation amount of Rs.25,00,000/- together with interest @ 6% p.a. thereon from 19.12.2013 till the date of payment.