Patient dies of Hemorrhagic shock post LSCS: Consumer Court holds medical negligence by doctor, hospital, directs Rs 20 lakh compensation

The bench ruled that it was a lack of adequate care after the LSCS that led the patient into hemorrhagic shock.

"There is something about losing a mother that is permanent and inexpressible - a wound that will never quite heal," NCDRC president R K Agrawal and Member S M Kantikar stated in the judgment, quoting author Susan Wiggs."We understand how challenging and painful a Mother's day without mom," the bench added.

The case dates back to 1995 when the patient during her 2nd pregnancy approached the hospital for a regular check-up. The concerned doctor had examined her and informed the couple that the baby was full-term, matured and the delivery could occur at any time. He further advised bringing the patient immediately on noticing pain, signs of bleeding or fluid.

A day after, at home, the patient started bleeding and immediately she was admitted to the treating Hospital. After examining her, the doctor had decided to perform a Lower segment Caesarean Section (LSCS); the consent for the same was obtained from her husband.

Later, the Anaesthetist arrived and the patient was taken to the operation theatre for LSCS under spinal Anaesthesia. It was alleged that the doctor had asked the patient's husband to get a bottle of Haemaccel which was immediately purchased from a local Pharmacist along with other medicines. Later, the patient delivered a female baby.

The complainant then stated that the doctor had told his assistant to call urgently another Gynaecologist and also told the relatives of the patient to arrange 'A-Negative' blood. "The person who went to the Blood Bank returned because the blood samples were contaminated, therefore pure samples were redrawn and given with a proper requisition slip to the Blood Bank and thereafter 4 bottles of blood were arranged.

However, in the meantime, due to anxiety, the co-brother of the Complainant contacted one Gynaecologist who performed 1st LSCS of the patient. She telephonically gave instructions to the treating doctor to shift the patient to Bhagwati Hospital at Borivali where she could perform an emergency hysterectomy to save the life of the patient.

In his petition, the Complainant had submitted that the 2nd gynaecologist arranged 18 bottles of A Negative blood at Bhagwati Hospital and requested a few doctors to remain present there.

It was further alleged that the relatives requested the doctor to shift the patient to Bhagwati Hospital, however, because of heated arguments between the doctor and the relatives, the request was refused; and when the things were beyond the control of the doctor and he realised the patient could not be saved, then decided to shift the patient to Bhagwati Hospital, the petition stated.

The patient was then shifted to Bhagwati Hospital but she was declared dead before admission. The Post-Mortem (PM) was performed and the cause of death was stated as "haemorrhagic shock following surgery".

Being aggrieved by the alleged deficiency and negligence during the treatment (LSCS) causing the death of the patient, the husband of the patient and two minor children filed a Consumer Complaint before the State Commission.

During that hearing, the hospital and the doctor denied all the allegations and admitted that it was 2nd LSCS and a female child delivered. The doctor submitted that because of the patient previous delivery and her rare blood group (A negative); he specifically advised the couple to go for a delivery, where a Blood Bank facility is available; however, the couple expressed their inconvenience going to other place and decided for delivery at his hospital.

The doctor stated that the patient's husband assured to arrange required blood but he failed to arrange blood in time, therefore, he had arranged the blood from a Blood Bank. After LSCS, the patient suffered profuse bleeding, therefore another Gynaecologist was called for help and made every possible effort to treat the complications.

Upon hearing the parties, the State Commission had partly allowed the Complaint and directed the hospital and the doctor to pay Rs. 16 lakh as compensation and Rs. 15,000/- towards the cost of the litigation to the Complainant.

Aggrieved with the commission's order, the hospital and the doctor moved the NCDRC seeking relief.

The NCDRC bench of Honourable justices president R K Agrawal and Member S M Kantikar heard the arguments at length from the learned Counsel on both sides and perused the material on record inter alia the Original record and the Order passed by the State Commission.

It noted the two questions which arose for consideration, first being whether the doctor failed in his duty of care and secondly whether it was reasonable care during treatment of the patient.

The bench then took note of an opinion and affidavit of a qualified Obstetrician and Gynaecologist, fled by the complainant to support his claim. The opinion was sought by the complainant through the Association for Consumers Action on Safety and Health (ACASH).

The expert opinion stated, "The patient was 'A' Rh- Negative and had 1st LSCS delivery; therefore for 2nd delivery, there were chances of unexpected uncontrolled haemorrhage. The treating doctor should keep sufficient "A negative" blood ready or make necessary arrangement to handle such complication... the "emergency hysterectomy" or "vessel ligation" was necessary."

The operative notes revealed that- there was difficulty in separating bladder and 1 inch lateral tear on both the sides of the uterus. It was one of the causes of bleeding. It is apparent from the record that the bleeding was not controlled for 1 ½ hour after the birth of the child. As per medical text under such circumstances, the "emergency hysterectomy" or "internal Iliac Ligation" was to be performed and then the patient could be shifted to the higher centre. Moreover, if we consider that of atonic uterus and adhesions caused primary haemorrhage which led to DIC; the patient could be saved if the blood and blood -3- components were given in time and later on the patient to be shifted the higher centre. Because cross-matched blood is not always available, maternity units should have immediate access (within 5 min) to O-negative blood. Consequently, in our view all maternity units should have their own reserve of blood products if there is no blood bank on-site, noted the bench.

The court went on to disagree with the doctor's witness claiming that blood donors were available before surgery and said,

"We don't agree because, there is nothing on record to prove that the Opposite Party No. 2 ( treating doctor) took sufficient steps to keep A Negative blood ready. Beforehand the patient's blood was not sent to the blood bank for Grouping & Cross matching." The judges further did not agree with the submission of the doctor and hospital that the cause of death of Amniotic Fluid Embolism (AFE).

The bench observed that the doctor had failed to control/arrest the bleeding. "It is evident from the clinical notes that he failed to take immediate surgical intervention or failed to refer the patient to any higher centre," it said. The commission said a crucial period of over five hours was lost before transferring the patient to another hospital.

Hence, holding negligence on part of the doctor, the bench maintained that he had failed to exercise reasonable skill and care as the delay in referral was fatal.

The bench then took references from a few medical textbooks on Obstetrics & Gynecology viz Munro Kerr's Operative Obstetrics - 13th edition, Williams Obstetrics- 20th edition.

The judges thereafter stressed on the duties of the doctors to the patient as elaborated by the Hon'ble Supreme Court in the case of Dr. Laxman Balkrishan Joshi Vs. Dr. Trimbak Bapu Godbole and Anr (AIR 1969 SC 128) observed as follows:

"The duties which a doctor owes to his patient are clear. A person who holds himself out ready to give medical advice and treatment impliedly undertakes that he is possessed of skill and knowledge for the purpose. Such a person when consulted by a patient owes him certain duties, viz., a duty of care in deciding whether to undertake the case, a duty of care in deciding whether treatment to give or a duty of care in the administration of that treatment. A breach of any of those duties gives a right of action for negligence to the patient. The practitioner must bring to his task a reasonable degree of skill and knowledge and must exercise a reasonable degree of care. Neither the very highest nor a very low degree of care and competence judged. In the light of the particular circumstances of each case is what the law requires."

"A mistake by a medical practitioner which no reasonably competent and a careful practitioner would have committed is a negligent one." the bench quoted its previous observation in a separate case.

The judges further quoted the opinion of Lord Denning, as expressed in Hucks vs. Cole, 1968 118 New LJ 469, "A medical practitioner was not to be held liable simply because things went wrong from mischance or misadventure or through an error of judgment in choosing one reasonable course of treatment in preference of another. A medical practitioner would be liable only where his conduct fell below that of the standards of a reasonably competent practitioner in his field." Thus in cases where the doctors act carelessly and in a manner which is not expected of a medical practitioner, then in such a case an action in torts would be maintainable, it said.

Dismissing the plea filed by the hospital and the treating doctor who runs it, the court held that it was a lack of adequate care after the LSCS that led the patient into hemorrhagic shock.

"Under these circumstances, and in the absence of any valid explanation by the Opposite Parties which would satisfy us that there was no negligence on their part, we have no hesitation in holding that *** (the patient) died due to negligence of Opposite Party No 2. It was an act of Omission from the Opposite Party No. 2 wherein it fell below that of the standards of a reasonably competent practitioner in his field."

On the matter of compensation, noting that the incident occurred in the year 1995 and currently this is 2021, the bench enhanced the quantum of compensation to Rs 20 lakh from

Rs 16 Lakh as previously ruled by the state forum. Rs 1 lakh towards litigation costs have also been imposed.

To view the detailed judgment, click here