Delay in registration with Medical Council not Negligence! NCDRC relief to gynaecologist
New Delhi: While exonerating a doctor accused of medical negligence while providing treatment to a pregnant woman, the National Consumer Disputes Redressal Commission (NCDRC) ruled that mere delay in registration with the State Medical Council, while being adequately qualified and having registration in the Indian Medical Register with the privilege to practice anywhere in India, does not amount to medical negligence or deficiency in service.
The history of the case goes back to 1994 when the complainant was in the early stages of her second pregnancy and sought consultation and treatment from the treating doctor- a gynaecologist. At that time, the doctor assured her that a normal delivery was expected. However, due to a delay beyond the expected delivery date, she was admitted to the treating hospital where the doctor was practising.
As the patient did not experience labour pain, the doctor instructed the use of cervix-prime and Pitocin drip to induce labour. However, after Pitocin was administered, the patient developed severe allergic reactions, leading to feeble pulses. Subsequently, the doctor performed a forceps-assisted delivery, after which her condition deteriorated, with a sudden drop in BP and massive bleeding, necessitating a hysterectomy.
The complainant alleged that during the administration of Pitocin, neither the doctor nor any medical personnel were present, and forceps delivery was conducted recklessly, causing a uterine rupture leading to a hysterectomy. The complications arising from her delivery and premature removal of her uterus were due to deficiencies in quality, nature, and performance of services provided by the treating doctor and hospital, amounting to medical negligence.
Additionally, there was a serious contradiction regarding her blood group. Initially, it was stated to be O+ and when the complications arose from the Pitocin allergy and forceps delivery, her husband arranged for O+ blood donors. However, it was later revealed that her blood group was AB-. Since AB- donors were unavailable, the treating doctor administered both AB- and B_ blood to her and she had to undergo the removal of her uterus, which she attributed to be the lack of proper care and it also resulted in the infant suffering from asphyxia, neonatal convulsion and birth palsy, requiring immediate treatment at Medical College Hospital, Calicut. Allegedly, the infant was hospitalized for four days and required follow-up visits three months.
Alleging medical negligence against the treating doctor and hospital complications that arose from forceps delivery and subsequent hysterectomy, filed a complaint seeking a compensation of Rs 3,00,250.
On the other hand, the treating doctor and hospital filed separate versions but raised identical defences, denying all material allegations made against them. They asserted that, as the complainant did not experience labour pains well beyond the anticipated delivery date, labour induction was recommended to prevent foetal distress due to the delay.
Accordingly, after the patient was admitted, cerviprime was applied and Pitocin was administered after this. Despite this, she did not develop labour pain and foetal distress was noted, necessitating a forceps-assisted delivery. After about half an hour after the child's delivery, she was reported to be experiencing bleeding, and steps were taken to manage it. In her best interest, and to avoid further life-threatening complications, hysterectomy was performed, submitted the doctor and the hospital, while refuting the allegations regarding mismatched blood transfusion, claiming that her husband had initially provided an incorrect blood group.
However, they asserted that cross-matching was conducted before taking any action and it was discovered that her complainant's blood group was AB-. Since AB-donors were unavailable, compatible negative blood groups that could be safely transfused were administered. They further claimed that there were no lapses in the complainant's treatment or the blood transfusion.
The District Commission dismissed the complaint. However, when an appeal was made before the State Commission, the State Consumer Court held that there was negligence in identifying the patient's blood group and informing different groups at different points of time found to be having some substance in examining the materials produced in the case.
"There is every reason to hold that her blood group was wrongly identified as AB+ve and accordingly informed to the complaint's husband to arrange blood for transfusion and just before such transfusion when the complainant was in a Critical condition, on matching the blood was identified as AB -ve. Donors of such blood groups not being immediately available other negative blood groups were transfused to complainant. Though we do not have anything to show that transfusion of other negative blood groups when ABve blood is not available is detrimental, still, the circumstances presented clearly reveal deficiency of service on the part of the hospital," the State Commission had held.
Accordingly, it had directed the hospital and doctor to pay the complainant a compensation of Rs 2 lakhs with 8% interest p.a. on such sum from the date of filing of the complaint till realization, along with Rs 50,000 as the cost of litigation.
When the matter was challenged before the Apex Consumer Court, apart from submitting the previous contentions, the complainant's counsel also argued that the treating gynaecologist was ineligible to practice modern medicine in Kerala as she failed to obtain requisite statutory registration with the State Medical Council at the time of treating and performing surgery on the complainant. Therefore, the treating hospital, which employed and permitted her to practice as a gynaecologist without such registration was equally liable.
On the other hand, the counsel for the treating doctor and hospital asserted that the doctor's failure to register within the State where the treatment was conducted could not be considered within the legal definitions of "medical negligence" or "deficiency in service". It was contended that at most, such omission would subject the practitioner to regulatory action by the relevant State Medical Council, which could impose disciplinary measures as per applicable statutory provisions. Therefore, they concluded that the State Commission's finding of medical negligence and deficiency in service was unjustified and prayed for the dismissal of the complaint.
While considering the matter, the NCDRC bench noted that all allegations were dismissed by both the District and State Commission, except for the issue of incorrect blood transfusion.
At this outset, the Commission noted,
"Upon reviewing the evidence on record and considering the limited scope of this Commission’s revisional jurisdiction, I find no reason to interfere with the detailed evaluation of evidence and reasoned finding arrived at by the learned District Forum and the learned State Commission, except the conflicting views between the said fora with respect to blood transfusion. Thus, the main question is whether the OPs were negligent or deficient in service with respect to transfusion of wrong blood group to the complainant, as alleged. In this regard the contention of OPs is that the complainant's blood group was incorrectly recorded as AB+ in both the case sheet and requisition slip, based on information provided at the time of admission by the complainant's husband. While the complainant denied this, there is no evidence on record to support her stand."
"It is undisputed that the OPs have in fact conducted an independent blood matching test prior to the transfusion, which revealed that her actual blood group was AB-ve, making it inappropriate to transfuse AB+ blood. It is further undisputed that B- blood was arranged and administered to the complainant during and after the hysterectomy. According to accepted medical practice, Bblood can be safely transfused to a patient with AB- blood. Regardless of the fact whether her husband provided incorrect input about her blood group, the critical fact remains that the OPs have specifically verified the correct blood group before administering blood, and a medically acceptable blood group was transfused. Therefore, I find no negligence or deficiency in service in this regard," it further observed.
Regarding the issue of the treating doctor's disqualification and registration with the Medical Council, the Commission referred to the relevant provisions of the Indian Medical Council, Act, 1956 stating "Subject to the conditions and restrictions laid down in this Act regarding medical practice by persons possessing certain recognised medical qualifications, every person whose name is for the time being; borne on the Indian Medical Register shall be entitled according to his qualifications to practice as a medical practitioner in any part of India and to recover in due course of law in respect of such practice any expenses, charges in respect of medicaments or other appliances, or any fees to which he may be entitled."
The NCDRC bench also noted that the issue of non-registration with the State Medical Council was not originally raised in the complaint. It also observed that there was no dispute regarding the fact that the treating doctor was a qualified medical doctor (gynaecologist) and there are no questions regarding her educational and professional qualifications as well as experience.
"Her admission to the Indian Medical Register which grants privilege to practice her field of medicine in any part of India is also undisputed. The contention at this stage is, she was not registered with Kerala Medical Council for practice in Kerala as on the date of she administering treatment to the complainant and that it constitutes negligence and deficiency in service. However, it is also undisputed that subsequently the registration of OP-1 was accepted by the Travancore Cochin Medical Council," note the Apex Consumer Court.
"Mere delay in registration with Travancore Cochin Medical Council, while being adequately qualified and held on the rolls of Indian Medical Register with privilege to practice anywhere in India, does not amount to medical negligence or deficiency in service by OP-1 with respect to the complainant. It is for the Travancore Cochin Medical Council or Kerala State Medical Council to take cognizance of this deviation, if any, as per rules," it further noted.
Therefore, after due consideration of the entire facts and circumstances of the case, NCDRC concluded, "...no medical negligence or deficiency in service of OPs is established. Therefore, the order of the learned State commission dated 28.02.2019 in FA No. 371 of 2010 is set aside and the complaint is dismissed."
To view the order, click on the link below:
