Delayed diagnosis of ectopic pregnancy, loss of fallopian tube: Consumer Court slaps Rs 20 lakh compensation on nursing home
Medical Negligence
New Delhi: The District Consumer Disputes Redressal Commission VIII (Central), Delhi, has directed a private nursing home in the city to pay Rs 20 lakh compensation to a woman, who suffered the loss of her fallopian tube and permanent infertility due to the medical negligence of a treating doctor.
The Commission observed that the treating doctor failed to diagnose the patient's ectopic pregnancy on time and also misrepresented her qualifications. Accordingly, the consumer court held the private nursing home vicariously liable for the acts of the doctor and ordered,
"After determining that medical negligence was conclusively attributed to OP1, which led to the permanent loss of motherhood suffered by the complainant, and OP2 is vicariously liable for the same, the component of relief to compensate the complainant comes into consideration. Though no amount of money can reduce the lifelong pain and emotional suffering that the complainant has to endure, yet, the same may provide some solace to meet future treatment or alternatives to have child."
"This Commission is of considered opinion that an amount of ₹ 20,00,000/- (twenty lakh) is fair, proportionate, legally justified, and commensurate with the nature, gravity, and irreversible consequences of the injury suffered by the complainant. The above stated amount includes litigation cost and miscellaneous expenses. OP2, the hospital, is directed to pay the above stated amount to the complainant within six weeks from the date of this order i.e. by 29.01.2026, failing which the amount shall carry an interest @ 9% per annum from 30.01.2026 until the actual realisation by the complainant. OP2 is at liberty to recover the said amount from the OP1 as per law," the Commission directed.
Case Background:
The case goes back to July 2020 when the patient tested positive for pregnancy at home. To confirm the same, she visited the concerned nursing home, where the treating doctor took charge of her case. It was submitted that the treating doctor confirmed the pregnancy solely based on the home urine pregnancy test (UPT) result, and without any independent check-up or investigation, prescribed certain medicines and also administered two injections to her.
The complainant/patient alleged that no tests were conducted, despite her request, despite the mandatory requirement that medication should follow proper examination, investigation, and a known diagnosis. Ultimately, a urine test was prescribed on her insistence for confirmation of pregnancy.
The patient claimed that the treating doctor treated her with utter negligence and disregard for medical norms, thereby "murdering her dreams and happiness by failing to take even basic care. No tests or check-ups were conducted to ascertain her condition, which ultimately led to the death of the foetus."
Allegedly, the treating doctor and the nursing home did not even mention any diagnosis on the treatment sheet, which was also a mandatory requirement. However, she followed the instructions of the treating doctor and consumed the medicines prescribed.
A few days later, the patient developed abdominal pain and continuous bleeding, and when she visited the nursing home, the treating doctor prescribed only acidity-related medicines. Her pain continued to increase, and she became bedridden. Nearly a month later, when she lost consciousness, her husband took her to another doctor, who was shocked at her condition and advised urgent tests.
The complainant was taken to a nearby laboratory, where the reports revealed the presence of a dead embryo in her womb. She was advised to seek immediate treatment at Kasturba Hospital. There, she was told that her condition was extremely critical and she was immediately operated upon. Her fallopian tube was removed to save her life. She was informed that she would never be able to conceive again due to extensive internal damage.
In this connection, a police complaint was lodged, and an opinion was sought from the Delhi Medical Council (DMC) regarding the treating doctor's conduct, qualifications, treatment records, and whether criminal negligence was involved. DMC Disciplinary Committee held that the treating doctor was not entitled to suffix M.S./M.D to her name, as that violated the Indian Medical Council Regulations, as she was registered only with the MBBS qualification. However, she was deemed ineligible to undertake antenatal cases.
The committee absolved the doctor from criminal negligence for the demise of the foetus, which resulted from a ruptured ectopic pregnancy. However, it also noted that the doctor prescribed medicines without proper investigation. Accordingly, the committee recommended issuing a warning to the doctor for shortcomings in treatment.
On the other hand, the treating doctor contended that she was merely a visiting doctor at the nursing home and, therefore, the treating nursing home was vicariously liable for any alleged act or omission. Reliance was placed on Mohammed Ajmal v. Indraprastha Apollo Hospital, where the State Commission held that in cases of medical negligence, hospitals or nursing homes alone are liable to compensate the patient for the loss or injury suffered by him/her, and that the nursing home/hospital had an independent remedy to take action against such doctor or staff. Reliance was also placed on the Supreme Court judgment in the case of Achut Rao v. State of Maharashtra.
Further, the doctor claimed that the complainant visited for gastric problems and pain in the upper liver area, not prenatal treatment. She further argued that she had prescribed an ultrasound, but the complainant failed to undergo it.
Observations by Consumer Court:
After considering the submissions and going through the medical records and case sheet, the District Consumer Court rejected the doctor's defence after noting that the treatment sheets showed that the treating doctor had noted "UPT positive" on the first visit but failed to get a confirmatory test or obstetric ultrasound.
At this outset, the Commission observed, "OP1 has not written the problems or complaints with which complainant had approached her;...No diagnosis was made by OP1 with respect to the problem identified, including the gastric problem claimed by OP1 to be afflicting the complainant or with respect to any other finding...OP1 did not mentioned any investigation for reaching the conclusion on the basis of which medicines were prescribed...Ultrasound was prescribed by OP1 on 02.09.2020 while the complainant had complained of bleeding and pain on 11.08.2020, 15.08.2020, 26.08.2020, and 02.09.2020 i.e., after five visits, approximately after 40 days from first visit."
"Despite OP1 herself treating the complainant as a 40-year-old patient and categorising her as a high-risk case, (as per the reply to the legal notice and the reply before the Disciplinary Committee) it is evident that OP1 failed to exercise the heightened degree of care, diligence, and monitoring mandatorily required in cases of such high-risk pregnancies. The conduct of OP1 in treating the complainant in a casual and negligent manner, while simultaneously acknowledging her as a high-risk patient, is internally inconsistent and establishes a clear breach of the duty of care, thereby constituting medical negligence...This conduct further demonstrates an impermissible shifting of responsibility, which cannot be sustained in law. OP1 wrongly portrayed the complainant as a 40-year-old high-risk patient and thereafter took the plea that considering the complainant’s age, she cannot be held liable. Such a defence is untenable, as the complainant’s actual age was 32 years, a fact duly recorded by OP1 herself in the treatment sheets," it further noted.
Further, after going through the treatment sheets, the Consumer Court concluded,
"The ultrasound dated 07.09.2020 showed an 8-week non-viable embryo, which means that 8 weeks had passed before the ectopic pregnancy was diagnosed. OP1 failed to rule out the ectopic pregnancy timely despite the complainant’s continued complaints of bleeding and abdominal pain. The delayed diagnosis was the proximate cause necessitating emergency surgical intervention that consequently resulted in removal of the fallopian tubes, thereby permanently extinguishing her reproductive capacity and closing her chances of conceiving again. Timely requisite treatment could not be administered to the complainant because of careless act of OP1. The degree of care, caution, and expected skill, which was higher in the present case was unfortunately lacking."
The Consumer Court cited the Supreme Court's decision in the case of Dr. Laxman Balkrishna Joshi v. Dr. Trimbak Bapu Godbole to hold that the treating doctoe breached the duty of care in deciding and administering treatment. Further, the Commission invoked the Bolam Test and observed that "no responsible body of medical opinion would consider it acceptable to ignore red flags" or avoid an early ultrasound for 40 days in a suspected pregnancy.
Addressing the issue of qualifications by the treating doctor, the Commission concluded that the treating doctor used the suffix "M.S." despite being registered only with an MBBS degree. The Commission relied on Poonam Verma v. Ashwin Patel and held that practicing without qualification is "negligence per se".
Referring to the judgment in the cases of Savita Garg v. National Heart Institute and Dr. Reba Modak v. Sankara Nethralaya, the Commission concluded that the treating nursing home was vicariously liable for the negligent acts of its doctors.
While determining the amount of compensation, the Commission relied on the Supreme Court judgment in the case of Malay Kumar Ganguly v. Sukumar Mukherjee and also considered the severity, thoughtfulness, and nature of the injury that caused irreparable harm and deprivation of the patient's legitimate expectation of motherhood. Accordingly, it directed the treating nursing home/hospital to pay Rs 20 lakh as compensation to the patient.
To view the order, click on the link below:
https://medicaldialogues.in/pdf_upload/ddcdrc-loss-of-falopian-tube-317449.pdf
